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1 0 0 <br />F. In -Tank Gauging / SIR Equipment: Z 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 />COMDlete the followini! checklist: <br />In the Section H, below, describe how and when these deficiencies were or will De corrected. ENVIRONMENTAL HEALTH <br />PERMIPSERVICES <br />G. Line Leak Detectors (LLD): <br />❑ Check this box if I.LDs are not installed. <br />'t-uill JIctC <br />Yes <br />tilt: iultv VY <br />❑ No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />❑ Yes ❑ No* <br />❑ Yes <br />❑ No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />❑ Yes <br />❑ No* <br />Was accuracy of system product level readings tested? <br />❑ Yes <br />❑ Yes <br />❑ No* <br />❑ No* <br />Was accuracy of system water level readings tested? <br />IN 'KEW 60 <br />Were all probes reinstalled properly? <br />❑ Yes <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />In the Section H, below, describe how and when these deficiencies were or will De corrected. ENVIRONMENTAL HEALTH <br />PERMIPSERVICES <br />G. Line Leak Detectors (LLD): <br />❑ Check this box if I.LDs are not installed. <br />'t-uill JIctC <br />Yes <br />tilt: iultv VY <br />❑ No* <br />mr,tticcnlia a. <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />❑ N/A <br />(Check all that apply) Simulated leak rate: 03 g.p.h.; ❑ 0.1 g.p.li ; ❑ U g.p.h. <br />Z Yes <br />❑ NO* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />Z Yes <br />❑ No* <br />Was the testing apparatus properly calibrated? <br />0 Yes <br />❑ No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ N/A <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />Z N/A <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />M N/A <br />or disconnected? -_ <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system I <br />Z N/A <br />malfunctions or fails a test? <br />❑ Yes <br />❑ No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />N/A <br />Z Yes <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In the Section H, below, describe how and when these deficiencies were or win ve curructuu. <br />H. Comments: <br />monitoring Certification Test Report 3 of 4 <br />