COMPLIANCE INFO_1999-2003 - Laserfiche WebLink

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Monitoring System Certification J I1f'J i v� Date of Testing/Servicing: Site Address: A i L:4 { � �1 � 1 F. In-Tank Gauging/SIR Equipment: a 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 ox if LLDs are not' talldd. /& W Complete the following checklist: �,,A � ,_�1��/ -- 1 ❑ 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: ❑3 g.p.h.'; ❑ 0.1 g.p.h.Z; ❑ 0.2 g.p.h.'- Notes: 1. Required for equipment start-up certification and annual certification: 2. Unless mandated by local agency,certification required only for electronic LLD start-up. ❑ Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? C1 Yes ❑ I�To* Was the testing apparatus properly calibrated?. ❑ Yes ❑ No*. For mechanical LLDs,does the LLD restrict product flow if it detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? •❑ N/A ❑ Yes ❑ 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 ❑ N/A malfunctions or fails a test? ❑ Yes ❑ No* For electronic LLDs,have all accessible wiring connections been visually inspected? ❑ N/A ❑ 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. H. Comments: