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Sep 26 06 10: 59a Rffr-da Test (209) 744-0116 p. 4 <br /> vnL:14uures,s: d <br /> 1 <br /> . -- ,.-.- ol•Testm�J4c v,c b �,� <br /> In-Tank Cttll cif'« � -- --- -- <br /> �. '0h�SIR �.[�llitlt�cnt, �cck this box if tank g.. - <br /> ►ugmli is nscd only for inventory control. <br /> C] Check this box if no tank 4auging or SIR equipment is installed. <br /> This section must be completed if in-lank gauging cclt.tipment <br /> I is used to perform leak detection monitoring. <br /> Complete the following Checkl'st: <br /> Q Yes ❑ No* Has all input wiring been inspected for proper entry and termination, inclutlin�� <br /> ❑ Yes ❑ No* Were aU lank gaug g 1 testing for ground faults? <br /> in �robcs visually inspected IbrE-elklist <br /> ldup?Yes U No" Was accuracy ofsystcn, product level readings teste4 Yes ❑ No' Was accuracy ofsystem, water level readings tested❑ Yes ❑ No* Weroall probes reinstalled properly? <br /> O Yes ❑ N • Wcrejall iten)s on the eyuipment manufacturer'slcted'l <br /> " In the Section H, below,j describe how:rl,d w4eu there de�ciertCiec were ur will be corrected. <br /> G. Zine Leak DetectorsLLD <br /> � ) C3 Check this box if LLDs are not insttdlcd. <br /> i <br /> C plete the following cllecklist: 1 <br /> Yes ❑ No* For equipment start-up or annual cyuipn,e t ertification, was a leak simulated to verify LLD performance? <br /> ❑ N/A (Check all that apply) Simulated leak rate g,pK, 00-19-P-11 ; ❑ 0.2 h. <br /> g•p- <br /> es ❑ No" Were all LLUs confirmed operational and accurate within regulatory requirements? <br /> Yes U No* Was the testing apparatus properly calibrated? <br /> Yes Q No* For mechanical LLDs,does the LLD restrict product flow if it detects a )cak4 <br /> ❑ N/A <br /> ❑ Yes ❑ NO* For electronic LLDs,docs the turbine automatically shut off it-the LI,D detects a leak? <br /> N/A <br /> Q Yes o* For elcMronic LLDs, does the turbine automatically shut of(,if any portion of the monitoring system is disabled <br /> N/A or disconnected? <br /> © Yes ❑ No* For electronic LLDs, docs the nu•bine automatically shut Off if any portion of the monitoring system <br /> N/A malfunctions or fails a lest? <br /> Yes No* For electronic LLDs, have all accessible wiring;conneclior)s been <br /> N/A visteally inspected? <br /> Yes a No' Were alilitcn-ts on the equipment manulacturer's maintenance checklist completed? <br /> r'jn the Section H, below,describe h and when these ftficiCncies were or will be corrected. <br /> I. Connments: <br /> 1 <br /> I <br />