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-Jun 11 04 12:33a Milo Dotten [2091 533-2650 p.3 Facility Name: Get -n -Go Mart (Page 3) In -Tank Gauging / SIR Equipment: ®Check this box if tank gauging is used only for inventory control. []Check this box if no tank gauging or SIR equipment is installed and disregard the following section. Codi tete the fallo ing checklist: ® Yes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ® 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 ❑ No* Was accuracy of system water level readings tested? ® Yes ❑ No* Were all probes reinstalled properly? ® 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. G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed and disregard the following section. ® Yes ❑ 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: ® 3 g.p.h.; ❑ 0.1 g.p.h; [10.2 g.p.h. ® Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? ® Yes ❑ No* Was the testing apparatus properly calibrated? ® Yes ❑ 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? ® N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled ❑ N/A or disconnected? ❑ Yes ® No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system ❑ NIA malfunctions or fails a test? ❑ Yes ® No* For electronic LLDs, have all accessible wiring connections been visually inspected? ❑ N/A IS Yes 1 ❑ No* I 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: