COMPLIANCE INFO_2005-2012 - Laserfiche WebLink

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Site Address:(9r~ "r—re'r-07,0�� _ Date of Testing/Servicing: &114114P F. In-Tank Gauging/SIR Equip nt: ieck this box if tank gauging is used only for inventorycontrol. ❑ 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? El 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 F❑ No* Was accuracy of system water level readings tested? ❑ Yes ❑ No* Were all probes reinstalled properly? ❑ Yes 1 CI 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: El"Ve-s ❑ 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: g.p.h. ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. GRO'Ves ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? es i_ ❑ No* Was the testing apparatus properly calibrated? es ❑ 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? U"MA 13 Yes El No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled /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: