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Site Address:v-'M 04o <br />9 i0c" yo g <br />Y of Testinb/Servicin g: / /_ <br />J '1041-2 P C_ � 4h <br />F. In -Tank Gauging /SIR Equipment: Teck 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 />COmDlete the followinu cheektict- <br />❑ Yes <br />❑ <br />No <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />❑ Yes <br />❑ <br />No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />❑ Yes <br />❑ <br />No* <br />Was accuracy of system product level readings tested? <br />❑ Yes <br />❑ <br />No* <br />Was accuracy of system water level readings tested? <br />❑ Yes <br />❑ <br />'No* <br />Were all probes reinstalled properly? <br />❑ Yes ❑ No* <br />iF In tha Q—t— Ll <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />1...1..... .1...... _:�._ 1----• ----' ---'- -_ .. ... --- <br />--. -- - , -- -•- - •• •• ••••.. ...........�� uc.—aux j— 1-1c of w1U De corrected. <br />G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. <br />ComDlete the followinu ehecklist! <br />es <br />❑ No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />13 N/A <br />(Check all that apply) Simulated leak rate: g.p.h.; C30.1 g.p.h ; C30.2 g.p.h. <br />❑ Yes <br />o* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />es <br />13No* <br />Was the testing apparatus properly calibrated? <br />U-7—es— <br />O No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />13N/A <br />E3 Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />@'' 1/A <br />❑ Yes <br />❑ <br />I <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />N/A <br />or disconnected? <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br />/A 1 <br />malfunctions or fails a test? <br />❑ Yes❑ <br />* <br />N/A <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />13"Yes <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In the ieetinn K. halnw fl—,;h. ti... A -1_ ------ <br />---- ___ ......... .....-.. ... ,..,., ......1 .a... ..., "Ulu. V1 will UC IVCTecteu. <br />H. Comments: 7-h al P, <br />7� -e TE -t s P�t e 7-/7 1-,` <br />