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Facility: Hammer 1-5 Arco <br />In -Tank Gauging / SIR Equipment: <br />®Check this box if tank gauging is used only for inventory control and disregard the following section. <br />❑Check this box if no tank gauging or SIR equipment is installed. <br />rmmnla+a *ha fnllnwinn rharklic+- <br />❑Yes <br />❑ No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground <br />faults? <br />El Yes <br />❑ No* <br />Were all tank -gauging probes visually inspected for damage and residue buildup? <br />❑Yes <br />❑ No* <br />Was accuracy of system product level readings tested? <br />❑Yes <br />❑ No* <br />Was accuracy of system water level readings tested? <br />El Yes <br />❑ No* <br />Were all probes reinstalled properly? <br />El Yes <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />G. Line Leak Detectors (LLD): <br />❑ Check this box if LLDs are not installed and disregard the following section. <br />®Yes <br />❑ No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD <br />❑ N/A <br />performance? (Check a// that app/y) Simulated leak rate: ® 3 gph; ❑ 0.1 gph; ❑ 0.2 gph. <br />®Yes <br />❑ No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />®Yes <br />❑ No* <br />Was the testing apparatus properly calibrated? <br />®Yes <br />❑ No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ N/A <br />El Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />® N/A <br />❑Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br />® N/A <br />is disabled or disconnected? <br />❑Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br />® N/A <br />malfunctions or fails a test? <br />No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />[7Yes <br />N/A <br />Yes <br />❑ No* <br />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: No Deficiencies. <br />Page 3 of 3 03/01 <br />