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Site Address: _'6020- ]?]1 E YOSEM]TE,R.._.r]TECA,CA 95336 Date ur Testin erviciri C <br /> F. In-Tank Gauging/ SIR Equipment: heck this box if tank gauging is 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 follo ing checklist: <br /> q Yes . No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> i ED Yes m No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ra. Yes [ No* Was accuracy of system product level readings tested? i <br /> Yes , No* Was accuracy of system water level readings tested? <br /> Yes No* Were all probes reinstalled properly? <br /> : Yes E 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 er willbe corrected. <br /> G. Line Leak Detectors (LLD): Ig Check this box ifLLDs are notinstalled. <br /> Com to the follo ing checklist: <br /> 'es No* For equipment start-up or arcual equipment cp1ification, was a leak simulated to verify LLD performance? <br /> NIA (Check all that apply) Simulated leak rate: h.l; fl,'0.1 g.p.h 2; M.0.2 g.ph 2 <br /> Notes: 1. Required for equipment start-up certification and annual certification. <br /> 2. Unless mandated by local agency,certificaticn required only for electronic LLD start-up. <br /> Ye No* Were allLLDs confirmed operational and accurate within regulatory requirements? <br /> e No* Was the testing apparatus properly calibrated? <br /> es No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> l'!N <br /> A <br /> Yes o* For electronic LLD s,does the turbine automatically shut off if the LLD detects aleak?A <br /> Yes * For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> !A or disconnected? <br /> Yes N For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions <br /> /A or fails ate at? <br /> Q' Yes M N For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> !A <br /> Yes •] 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 /> i <br /> _ I <br /> i <br /> I <br /> Page 3 of 3 03.01 <br />