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Site Address:_ 5469: 130S WILSON WA fOCKTON, CA 95205 <br />_ .DL ,f Testsngaervicing: <br />F. In -Tank Gauging/ SIR Equipment: heck this box if tank gauging is used only for inventory control. <br />Check this box if no tank gauging or SIR equipment is instated. <br />This section must be completed if in -tank gauguig equipment is used to perform leak detection monitorui lg, <br />Camnlete the fellowiro rhorklic,t- <br />ly E Yes <br />No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />es <br />JR No* <br />Were all teak gaugingprobes visually inspected for damage and residue buildup? <br />No* <br />Was accuracy of system product level readings tested? <br />FYes <br />� <br />No* <br />Was accuracy of system water level readings tested? <br />Yes <br />No* <br />Were all probes reinstalled properly? <br />es <br />++ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />1n ane oecuun ri, oelow, uesczwe MOW axa Wnen McSe UeACLencleS were or vau he corrected. <br />�n <br />G. Line Leak Detectors (LLD): Q Check this box if LLDs are not installed- <br />Comnle,tm the fellowinu rhPrklist! <br />ILY es <br />P No* <br />For equipment start-up or annual equipmen certification, was a leak serrulrm <br />ated to verify LLD perfoen <br />C3 NIA <br />(Check all that apply) Simulated leek rate g.p.h,1; 0.1 g.p.h?; 0.2 g.p.h 2 <br />Notes: 1. Required for equipment stert-up certifications annual certification. <br />2. Unless mandated by local agency, certification required only for electronic LLD startup. <br />Yes <br />No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />es <br />No* <br />Was the testing apparatus properly calibrated? <br />es <br />o* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />IA <br />Yes <br />No* <br />For electronic LLIX does the turbine automatically shut off if the LLD detects a leak? <br />NIA <br />Yes <br />No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />NIA <br />or disconnected? <br />O Yes <br />Q No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system mdfunc'.ions <br />N/A <br />or fails a test? <br />M -Yes <br />r7i No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />° <br />p NIA <br />s <br />. No <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In the Section H, below, describe how and when these deticienc3es were or will be eonvcte d. <br />H. Comments: 1 <br />Page 3 of 3 03,01 <br />