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F. In -Tank Gauging / SIR Equipment: ❑ 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 />Comnlete the following checklist: <br />es <br />❑ No* <br />Has all input wiring been inspected for proper entry and termination, including -testing-for—ground faults? <br />,5:37es <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 />es <br />❑ No* <br />Was accuracy of system water level readings tested? <br />es <br />❑ No* <br />Were all probes reinstal1ed'pr6perly? <br />Yes <br />I ❑ No* I <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />- to the Section it, beiow, aescrine now ana wnen tnese aenciencies were or will be corrected. <br />G. Line Leak Detectors (LLD): <br />Comnlete the fnllnwinsr eheeklist- <br />❑ Check this box if LLDs are not installed. <br />es <br />❑ No* <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: bllrg.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. <br />C3No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />Ves <br />❑ No* <br />Was the testing apparatus properly calibrated? <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 />❑ 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 />❑ 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 <br />❑ 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 />_ <br />❑ N/A <br />Yes <br />❑ No* I <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />- to we aecuuu n, ueiow, aescnoe now ana wnen these oeliciencies were or will be corrected. <br />H. Comments: <br />Testing Company Name: TANK-TEK ENVIRONMENTAL <br />ONMENTAL CORPORATION <br />Site Address: 1524 ��N0 A -AV <br />Phone No.: (707) 446-6151 <br />Date of Testing/Servicing: ZL <br />Page 3 of 3 03/01 <br />