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Site Address: 6100 N HWY 99 Date ofTesting/Servicing. <br /> F. In-Tank Gauging/ SIR Equipment: d Check this box if tank gauging is used only for inventory control. <br /> f 6100 N HWY 99 , Check this box if no tank gauging or SIR equipment is installed. <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. <br /> Complete the following checklist: <br /> �s MNo* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> Q' Yes j] No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> Yes A, No* Was accuracy of system product level readings tested? <br /> Yes No* Was accuracy of system water level readings tested? <br /> Yes No* Were all probes reinstalled properly? <br /> Yes Cl No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> *In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors (LLD): 1Check this boxifLLDs are notinstalled. <br /> Co" to the follow' g checklist: <br /> WlAes No* For equipment start-up or annual equipment c cation was a leak simulated to verify LLD performance? <br /> NIA (Check all that apply) Simulated leak rate: g.p.h.1; Q 0.1 g.p.h.2; VC0.2 g.p.h.2 <br /> Notes: 1. Required for equipment start-up certification and annual certification. <br /> 2. Unless mandated by local agency,certification required only for electronic LLD start-up. <br /> lYe �1 No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> w?es . No* Was the testing apparatus properly calibrated? <br /> p. Yes 19, <br /> For mechanical LJ_Ds, does the LLD restrict product flow if it detects a leaw. <br /> °a' N/A <br /> Yes No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br /> N/A <br /> Yes No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> NIA or disconnected? <br /> Yes ": No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions <br /> NIA or fails a test? <br /> es 7 No* For electronic LLD s,have all accessible wiring connections been visually inspected? <br /> -- N!A <br /> Yes t]. No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> *In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> i <br /> Page 3 of 3 03x1 <br />