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Site Address: 3425 TRACY BLVD Date of Testing/Servicing: / 6y <br /> F. In-Tank Gauging f SIR Equip: KCheck <br /> this box if tank ging is used only for inventory control. <br /> 3425 TRACY BLVD thisbox 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 to the followfig checklist: <br /> es No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> es No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> e No* Was accuracy of system product level readings tested? <br /> M No* Was accuracy of system water level readings tested? <br /> Y M. No* Were all probes reinstalled properly? <br /> Yes No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> *In the Section H,below,descrile how and when these deficiencies were or will be corrected. <br /> VIM <br /> G. Line beak Detectors (LLD): ( Check this box ifLLD s are not installed. <br /> Com he follo ing,checklist: <br /> es No* For equipment start-up or annual equipmentrtification, was a leak simulated to verify LLD performance? <br /> NIA (Check all that apply) Simulated leak rate: ✓ g.p.h- 1; M,0.1 g.p.h.a; M�0.2 g.p.h.a <br /> Notes: 1. Required for equipment start-up certification and annual certification. <br /> 2. Unless mandated by local agency, certification required only for electronic LLD start-up. <br /> Yes No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> Yes No* Was the testing apparatus properly calibrated? <br /> 4Yes0* For mechanical LLDs,does the LLD restrict product flow ifitdetects aleak? <br /> VIA <br /> Yes No* For electronic LLDs, does the turbine automatically shut off if the LID detects a leak? <br /> NIA <br /> Yes _ No* For electronic LJ-Ds, 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 /> Yes No* Were all items on the a quipment manufacturer's maintenanc a checklistcompleted? <br /> *In the Section H,below,descrbe how and when these deficiencies were or willbe corrected. <br /> H. Comments: <br /> pLLP S it/nT 3 D 60/Y <br /> Page 3 of 03A1 <br />