COMPLIANCE INFO_1999 - 2003 - Laserfiche WebLink

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Date of Tesli,►g/Scrvicing: 'd Site Addicss: z I,'. In-Tank Gauging /SIR Equipment: ❑ Check(his hox if lank gauging is used only for inventory control. Check this box if no tank gauging or SIR equipment is installed. 'l'ltis scc:tion must be completed if in-tank gauging ccluipiucnt is used to perform letik detection monitoring. COM We the followin checklist: — - ❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? ❑ Yes Cl 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 tl►e Section 11,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. (:om tele the 0 ing checklist: [ !Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? [I N/A (Check all that apply) Simulated leak rate: Z?3 g.p.h.�; ❑0.1 g.p.li.2; C]0.2 g.p.h.2 Notes: 1. Required for equipment start-up certification and annual certification. 2. Unless mandated by local agency,certification required only for electronic LLD start-up. Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? 1'es ❑ No* Was(lie testing apparatus properly calibrated? Yes ❑ No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? ( ❑ N/A [l Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabler N/A or disconnected? ❑ Yes ❑ No* For electronic LLDs,does the turbine automatically shut oft'if any portion of the monitoring system malfunction: N/A or fails a test? El Yes ❑ No* For electronic LLDs,have all accessible wiring connections been visually inspected? N/A Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed'? * In the Section 11,below,describe how and when these deficiencies were or will be corrected. 11. Colrntrteuts: -- Page 3 of 3 03101