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Site Address: SS #5469,130 S WILSON WAY, STOCKTON F. In -Tank Gauging / SIR Equipment: Date of Testing/Servicing: L3 '61 ❑ Check this box if tank gauging is used only for inventory control. � Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. Cmmnlete the follnwinu checklist! ❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? ❑ Yes ❑ No* Was accuracy of system product level readings tested? ❑ Yes ❑ No* Was accuracy of system water level readings tested? ❑ Yes ❑ No* Were all probes reinstalled properly? ❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. Cmmnlete the fnllnwinu rherklist- fel Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? 9 1 Al . (.. D• ❑ N/A (Check all that apply) Simulated leak rate: ❑ 3 g.p.h.1; ❑ 0.1 g.p.h.2; [10.2 g.p.h.2 SnU�f r CJ'0,.,1 �G c , -O _ Notes: 1. Required for equipment start-up certification and annual certification. 2. Unless mandated by local agency, certification required only for electronic LLD start-up. ❑ Yes J2 No* Were all LLDs confirmed operational and accurate within regulatory requirements? Yes ❑ No* Was the testing apparatus properly calibrated? Yes ❑ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ N/A R] Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑ N/A I9 Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled ❑ N/A or disconnected? L2 Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions ❑ N/A or fails a test? ® Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? c ❑ N/A Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. - H. Comments:,s'rc11�r 9 1 Al . (.. D• CPT SnU�f r CJ'0,.,1 �G c , -O _ Page 3 of 3 03/01