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Site Address: Date of Testing(Servicing: <br />F. In -Tank Gauging SER Equipment: [I Check this box if tank gauging- is used only for inventory control. <br />r❑I Check this box if no tank gauging or SIR equipment is installed. <br />MAKIN <br />Has all input wiring been inspected. for proper entry and termination, including testnfor ground bults? <br />ig <br />For equipment start-up or annual equipment cqptification, was a leak simulated to vm* LLD performance? <br />Were all tank gaugmg probes vistally inspected for damage and rmdue buildup? <br />jj <br />MT <br />103 <br />2CCC�. Unless mandated by local agency. certification required only for electronic LLD start-up. <br />In the Section H, below, describe how and when these deficiencies were or will be corrected. <br />G. Line Leak Detectors (LLD): 0 Check this box if LLDs are not installed. <br />rMnMAaP <br />Page 3 of 3 03/oi <br />For equipment start-up or annual equipment cqptification, was a leak simulated to vm* LLD performance? <br />2: 2 <br />(Check all that apply) Simulated leak rate: El 3 g-p.IL 1; 0 0. 1 g.p.h. . 0 0.2 g.p.h. <br />j Notes: 1. Required for equipment stan-up certification and annual certification. <br />2CCC�. Unless mandated by local agency. certification required only for electronic LLD start-up. <br />5 40"11 fe. I (;at's i A I A I <br />51120� <br />0 <br />Was the testing apparatus properly calibrated? <br />■ <br />rM <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />For electronic 11,D& does the turbine automatically shut off if the LLD detects a leak9 �71 <br />C LILLAIM automatically MuU5ft-TT7MPOMrWftMOn7o Me monitoring systern is di <br />z <br />or disconnected? <br />X <br />BE=' <br />♦For electronic LLDs, Tot;i_the turbine alltOM26caUy shut off if aW pardon of the monitoring system I <br />malfimcdons or fails a test? <br />For electronic LLD& have all acc e wiring connections been visually inspected? <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />Page 3 of 3 03/oi <br />