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Site Address: 0595:6100 N HWY 99,STO' -ON,CA 95212 Dat Testin ervic <br /> P' <br /> • w <br /> F. In Tank Gauging f SIR Equipment: ,, eck this box if tank gaugingis used only for inventory control. <br /> 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 /> Com lete the followN checklist: <br /> Yes M, No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> Yes M No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> Yes No* Was accuracy of system product level readings tested? <br /> (7 Yes No* Was accuracy of system water level readings tested? <br /> Yes No* Were all probes reinstalled properly? <br /> Yes No* Were allitems onthe equipment manufacturer's maintenance checklist completed? <br /> *In the Section H,below,describe how and when these deficiencies wen or will be corrected. <br /> G. Line Leak Detectors (LLD): ,Check this boxifUDs are not installe d. <br /> Cont to the h1lowift checklist: <br /> es No* For equipment start-up or annual equipment prLification, was a leak simulated to verify LLD performance? <br /> NIA (Check all that apply) Simulated leak rate: g.p.h.1; �I 0.1 g.p.h 2 0.2 g.p.h 3 <br /> Notes: 1. Required for equipment start-up certification Md annual certification. <br /> 2. Unless mandated by local agency,certification required only for electronic LLD startup. <br /> es S No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> es M No* Was the testing apparatus properly calibrated? <br /> Yes r No* FormechanicalLLDs, does the LLD restrict product flow if it detects aleck. <br /> IA <br /> Wl?es No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br /> NIA <br /> es [] No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> NIA or disconnected? <br /> es 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 kq No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> NIA <br /> es 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 /> Page 3 of 3 0101 <br />