COMPLIANCE INFO_2000-2005 - Laserfiche WebLink

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i` Monitoring System Certification Site Address: Date of Testing/Servicing: F. In -Tank Gauging / SIR Equipment:Check this box if tank gauging is used only for inventory control. ❑ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in -tank gauging equipment is used to .perform leak detection monitoring. Complete the following checklist: ❑ Yes ❑ No* . Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ❑ Yes ❑ No* Were all tank gauging probes visually inspected for. damage and residue buildup? ❑ Yes ❑ No* Was accuracy of system product level readings tested? ❑ Yes ❑ No* Was accuracy of system water level readings tested? ❑ Yes Cl No* Were all probes reinstalled properly?_ - ❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. Complete the following checklist: Yes ❑ No* For equipment start-up or annual- equipment certification,- was a leak simulated to verify LLD performance? ❑ N/A (Check all that apply) Simulated leak rate:,J�'3- g.p.h:"; ❑ 0.1 g.p.h.� ❑ 02 g_p.h? Notes: i_ Required for equipment start-up certification and annual certification. 2. Unless mandated by local agency, certification required only for electronic LLD start-up. tart up.Yes XYes Cl No* Were all LLDs confirmed operational and accurate within regulatory requirements? Yes •❑ No* Was the testing apparatus properly calibrated? es ❑ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ NIA ❑ Yes ❑ No* -Forelectronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑ Yes a No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled N/A or disconnected? ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system ,0 N/A malfunctions or fails a test? ❑ Yes ❑ No*. For electronic LLDs, have all accessible wiring connections been visually inspected? N/A Yes 10 No* I Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H_ below. describe how and when these deficiencies were or will be corrected_ H. Comments: CA i .M_M Pace 3 of 3