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S S 6020: 1711 E YOSEMITE MA' '-- CA,CA 95336 Date of Testin :ervicing: i9/7/2N5 <br /> F. In-Tank G auging t SIR E quipment: Check this box if tank gauging is used only for inventory c ontrol. <br /> Check this box if no tank gauging or SIR equipment is irut celled. <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. <br /> Com fete the follow checklist: <br /> LY <br /> No* Has all input wiring been inspected for proper entry and termination,including testing for ground fault?No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> No* Was accuracyofsystemproductlevelreadingstested? <br /> No* Was accuracyof system water level readings tested^i No* Were all probes reinstalled properly? <br /> No* Were all items on the e quipment 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 box if=s are not installed. <br /> Complete the follow' checklist: <br /> Yes No* Far equipment start-up or annual equipment certification, was a leak simulated to verify ILD pe armance? <br /> NPA (Check all that apply) Simulated leak rate: g.p.h.l; ®G.I g.p.h 2; ®02 g.p h.2 <br /> Notes: 1. Required for equipment startup certification and annual certification. <br /> 2. Unless mandated by local agency,certification required only for electronic LLD start-up. <br /> Yes X No* Were a11LI.Ds confirmed operational and accurate within regulatory requirements? <br /> Yes No* I Was the testing apparatus properly calibrated? <br /> Yes No* For mechanical LLDs,does the LLD restrict product flow if it detects aleaw. <br /> NIA <br /> Yes No* For electronic LLD9,does the turbine automatically shut off if the LLD detects aleck? <br /> NIA <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 /> Yes No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> NIA <br /> -11 Yes Ig No* I 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: l L <br /> r <br /> i <br /> Page 3 of 3 03.01 <br />