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HECEIVEL <br /> F.In-Tank Gauging/SIR Equipment: r Check this box if tank gauging is used only for inventory conVA <br /> . 0 4 2015 <br /> r Check this box if no tank gauging or SIR equipment is instalk AI,� <br /> This section must be completed if In-tank gauging equipment is used to perform leak detection monitoring.p g 9 g. '�NVIRONMENTA! <br /> Complete the following Checklist: .• �*Z',•��'� <br /> ♦ Yes No" ias all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> • Yes - No• Nere all tank gauging probes visually inspected for damage and residue buildup? <br /> • Yes No' Nas accuracy of system product level readings tested? <br /> • Yes No' Nas accuracy of system water level readings tested? <br /> • Yes No* Nere all probes reinstalled properly? <br /> • Yes No' Nere 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 be corrected. <br /> G.Line Leak Detectors(LLD): r Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> IT Yes No* or equipment start-up or annual equipment certiflutio,.n+.was a leak simulated to verify LLD performance?(Check all that <br /> N/A apply)Simulated leak rate:*r 3 g.p.h.; r 01 g.p.h; I 0.2 g.p.h. <br /> IT Yes No" Nere all LLDs confirmed operational and accurate within regulatory requirements? <br /> • Yes - No- Nas the testing apparatus properly calibrated? <br /> • Yes No* For mechanical LLDs,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 /> • N/A <br /> Yes No' For electronic LLDs that are programmed for positive shut down,does the turbine automatically shut off if any portion of the <br /> N/A onitoring system is disabled or disconnected? <br /> • <br /> Yes No* or electronic LLDs that are programmed for positive shut down,does the turbine automatically shut off if any portion of the <br /> • N/A onitoring system malfunctions or fails a test? <br /> Yes - No' or electronic LLDs,have all accessible wiring connections been visually inspected? <br /> • N/A <br /> IT. Yes No* ere all items on the equipment manufacturer's maintenance checklist completed? <br /> 7-1-n the section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> Page 3 of 3 12/07 <br />