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Site Address: 110 W.TURNER RD <br /> Date of Testing/Servicing: t/28!08 <br /> F. In-Tank Gauging/SIR Equipment: 0 Check this box if tank gauging is used only for inventory <br /> control. <br /> ❑ Check this box if no tank gauging or SIR equipment is <br /> This section must be Completed if in-tank �u <br /> installed. <br /> p gauging equipment is used to perform leak detection monitoring. <br /> Complete the followin cheMist: <br /> (8 Yes ❑ No** Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> ® Yes ❑ No Were all tank gauging probes visually inspected for damage and residue build ? <br /> 19 Yes ❑ No* Was accuracy of system product level readings tested? <br /> 0 Yes ❑ No* Was accuracy of system water level readings tested? <br /> ® Yes ❑ No* Were all probes reinstalled properly? <br /> ® Yes ❑ No* I Were all items on the equipment manufactu rer,s maintenance checklist completed? <br /> *1n the Section H,below,describe how and when these deficiencies were or wil!be corrected. <br /> G. Line Leak Detectors(LLD): ® Check this box if LLDs are not installed. <br /> COMBfete the followi8 checklist! <br /> ❑ Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD <br /> ❑ N/A (Check all that apply) Simulated leak rate: ❑3 g.p.h.r; ❑0.I h.2 2 <br /> performance? <br /> Notes: 1. Required for Bua ❑02 g.. <br /> equipment start-up certification an annual certification. <br /> 2. Unless mandated by local agency,certification required only for electronic LLD start-up. <br /> ❑ Yes ❑ No* Were al!LLDs confirmed operational and accuraDe within regtrlat <br /> ❑ Yes ❑ No* Was the testing apparatus proper!},calibrrated? on'requirements? <br /> ❑ Yes ❑ No• For mechanical LL n,does the LLD restrict product flow if it detects a leak? <br /> ❑ N/A <br /> ❑ Yes ❑ NO For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> 13 N/A <br /> ❑ Yes I QNo* For electronic LLDs,does the turbine automatically shut off if an <br /> C3 N/A <br /> or disconnected? y portion of the monitoring system is disabled <br /> ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if an <br /> 13N/A malfunctions or fails a test? Y portion of the monitoring system <br /> ❑ Yes ❑ No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> r-1 NIA <br /> ❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> *1 the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H.Comments: <br /> r <br />