COMPLIANCE INFO_2004-2008 - Laserfiche WebLink

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Alo"i;tOY169 System Certification Site Address: y N i 1 oo �e,r } Date of'resting I / 'F. In -Tank Gauging/ SIR Equipment:❑ Check this box if tank gauging is used only for inventorycontrol. Check this box if no tank gauging or SIR equipment is installed. s 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 tes ❑ 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 ❑ 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 mplete the following checklist: Yes ❑ No* For equipment start-up or annual equipme t certification, was "a leak simulated to ❑ N/A (Check all that apply) Simulated leak rate: 3 g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. for ground faults? LLD performance? 4 Yes 113 No* Were all LLDs confirmed operational and accurate within regulatory requirements? Yes ❑ No* Was the testing apparatus properly calibrated? ❑ Yes ❑ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? Pr N/A Yes ❑ No* 7] 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? X 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? r Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? ❑ N/A 3' 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. I. Comments: