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Apr 20 04 08: 44a LMH Facilities Management 12,6 339-71372 P. 9 <br /> mopit.cring.Systent Certification <br /> Site Address', , /Gk±'t wc of 1'eNtmg/Scrvicin.. <br /> 1?7�_ 5, 1:� <br /> . _ Ay <br /> F. In (:augins',/Slit Etluipinesit: LMI-icck this box il"tank gaugiiv,is used only for inventory control. <br /> U Check this box if no tittik gaugiiiA or SIR equipment is installed. <br /> This section must bCc()n1PIetCd it-in-tank gaughir,cqmpinetlt is used to perllorvi le;ik detection monitoring. <br /> Complete the following checklist, testing for ground faults? <br /> U Yes Q No- Has all input wiring been inspcoctl liar prnper cvivy and terl"i'mLiOn.including <br /> 0 Yes 0 Ne--Wcmall tank ganging j)robc_%visually inspected for damage'asid residue Ouildup'l <br /> 13 Yes 0 No- Was ol'systen)product level readings(ested'I <br /> 7 <br /> Yes d—Ne accuracy Was accucy of systein water level readings tested! <br /> O Yes 13 Roo Were al I probes l-eilistalled properly'! <br /> I Were all items on the equitinictit maimcnance clieck lio�;olnpleted? <br /> • O I a-ve(ed. <br /> in the section H,below,describ4c Itow and when these deficiencies weir(At-will he Cot <br /> G. Line Leak Detectors(LLD): L&I"ftcck this box ii'LLDs arc not installed, <br /> C r <br /> Complete the following—chccklisC. <br /> 0 Yes 9 NTor equipract, <br /> t start-up or annual equipment rcrtificItiOtt, Was it leak simulated to verify UD performance? <br /> Ll N/A (Ch(.,cAt)jjj(,aiapply) Simulated leak rate: C3 3 g-ph.; 0 0.1 g-p-h ; 0 0.2 g.p.h- <br /> 0 Yes C1 No- Were all LILDS contirmed operational and accurate within regulatory requircincriEs'l <br /> (3 yes [3 Nos WRs the testing apparatus properly calibrated? <br /> d-TcT, NO* For mechnnicaD LI)c,does the 1.1-1)restrict product flow if it detects a leak'? <br /> 0 NIA <br /> Q Yes IJ Now l,or electronic LLD%,does(lit turbine automatically shut off if ilii LLD detects a leak' <br /> Q N/A <br /> 0 Yes U No* For electronic LUX does the turbille automatically Shut off if any portion of monitoring system is disabled <br /> Q N/A or disconnected7 <br /> U Yes -IlUt Off it any portion 431' the monitoring SYS(CM <br /> Q No* I`or electronic LLDs, does (lie tut aulonlilk:ally S <br /> U N/A malfunctions or fails a test? <br /> U Yes U No* for�electronic LLI)s.have all aceessiblr WiVifl;,cunnections been visually inspected? <br /> U N/A I I <br /> r <br /> UY csU • ccivis on the cqumm <br /> ipeittanufm <br /> acturcr*s ainicnance checklist completed'? <br /> _ —7_ <br /> .........*Wwwl — <br /> In the Section H.titlow,describe how and when these deficiencies were or will ecorrected. <br /> H. Comments: <br /> ----------- <br /> Page 3 o r 3 <br /> PIT !Qn *n n2 jclw <br />