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.V.-.... ....�. V j01 v .. ..i.... ... .aC-. . <br />Site Address: 1210 E. HAMMER LANE <br />• b WEST LANE <br />F. In -Tank Gauging / SIR Equipment <br />Check this box if no tank gauging or SIR equipment is installed. <br />Date of Testing/Service. 07/07/2011 <br />❑ Check 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 />Complete the following checklist: <br />❑ Yes <br />Q No * <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />0 Yes <br />❑ No * <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />QYes <br />❑ No * <br />Was accuracy of system product level readings tested? <br />ElYes❑ <br />No * <br />Was accuracy of system water level readings tested? <br />X Yes <br />❑ No * <br />Were all probes reinstalled properly? <br />El Yes <br />❑ No * <br />Were all items on the equipment manufacturers' maintenance checklist completed? <br />" In the Section H, below, describe how and when these deficiencies were or will be corrected. <br />G. Line Leak Detectors (LLD) : ❑ Check this box if LLDs are not installed. <br />Complete the following checklist: <br />Q Yes <br />❑ No * <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />❑ N/A (Check all that aPPIY) Simulated leak rate: ❑ 3 9•P•h❑ 0.1 9•P•h 0.2 9•P•h <br />FX -1 Yes <br />❑ No * <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />X Yes <br />❑ No * <br />Was the testing apparatus properly calibrated? <br />® Yes <br />❑ No * <br />® N/A For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ Yes <br />❑No * <br />® N/A I For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />❑ Yes <br />❑No * <br />Q N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br />❑Yes <br />E] No * <br />FX N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br />❑ Yes <br />❑No * <br />0 N/A For electronic LLDs, have all accessible wiring connections been visually inspected? <br />1=1 Yes <br />[:]No * <br />Were all items on the equipment manufacturers' maintenance checklist completed? <br />. In the Section H, below, describe how and when these deficiencies were or will be corrected. <br />H. Comments: <br />Page 3 of 3 Based on CA form dated 03/08 <br />