COMPLIANCE INFO_2000 - 2011 - Laserfiche WebLink

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Site Address: _ Date of Testing/Servicing: V' /� 7/� F" In-Tank Gauging/ SIR Equipment: Cl-efieck 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. Complete the following 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. Complete the following checklist: Erlre—s ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? ❑ N/A (Check all that apply) Simulated leak rate: Cl- g-1s.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. U-Tes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? es ❑ No* Was the testing apparatus properly calibrated? EY-Y-es ❑ No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? U-N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled p--N/A or disconnected? ❑ Yes ❑ No* For electronic LLDs, does (lie turbine automatically shut off if any portion of the monitoring system p- q/-A malfunctions or fails a test? ❑ Yes ❑ Nr* For electronic LLDs, have all accessible wiring connections been visually inspected? 131'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: