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i_71 <br /> Site Address: '2130,.7906 N EL DORADO11P3TOCKTON,CA 95210 <br /> F. Ih-Tank Gauging/SIR Equipment: jeckthis box if tank gauging is used only for inventory control. <br /> g <br /> Check this box if no tonic gauging or SIR equipment is installed. <br /> This section must be completed if in-tank gau&W equipment is used to perform leak detection monitoring. <br /> Complete the ren�o Ing checklist- <br /> yes No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> Yes M No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> Yes Was accuracy of system product level readings tested? <br /> Yes—, 0 Was accuracy of system water levelreadings tested? <br /> Yes _ajN_o* Were all probes reinstalled properly? <br /> M:Yes— U-14o* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> In the Section H,below,describe kow and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors (LLD): r6heck this box if LLDs are not installed. <br /> con"the fens checklist: <br /> MI?as No*' Far equipment startrup or annual equipment SpetIcation, was a leak simulated to verify LLD performance? <br /> MIA (Check all that apply) Simulated leak rate: Iff; g.ph.1; 5,0.1 g.ph.2; M-0,2 g.p.h,2 <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 stert.up. <br /> No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> No* I Was the testing apparatus properly cahbrated? <br /> to Nz*�O For mechanical LLD9,does the LLD restrict product flow if it detects a leak? <br /> NIA <br /> FyesY lee I No* For electronic UDs,does the turbine automatically shut off if the UM detects a leak?. <br /> NIA <br /> O'Yes No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> NIA or disconnected? <br /> O'Yes No* For electronic LLDP, does the turbine automatically shut off if any portion of the monitoring system mah%nctions <br /> NIA or fails atest? <br /> KYes NO* For electronic LLDs,have all accessible wining connections been visually inspected? <br /> NIA <br /> GrYes No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> In the Section H,below,describe how and when tivese deficle;;n:—s were or In corrected. <br /> IL comments: <br /> Page 3 of 3 03MI <br />