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r <br />F. In -Tank Gauging / SIR Equipment: Check this bots if tank gauging is used only for inventory control. <br />This section must be completed if in -tank gauging eq*pment is used to perform leak detection monitoring. <br />616_ n.,.err� .a.�..r.rre►. <br />D yes <br />0 No* <br />Hn all input wiring been inspected for proper entry and termination. including tasting for ground faults? <br />0 Yes <br />0 No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />❑ Yea <br />0 No* <br />Was accuracy of system product level readinp tested? <br />O Yes <br />0 No* <br />Was accuracy of system water levil readings tested? <br />D Yes <br />O No* <br />Were all pmbes reinstalled propariy? <br />Q Yes <br />❑ No* <br />Were all items on tete equipment nisaufsctuar'3 mainte wce checklist completed? <br />* In the Seedon H, below, deserme how and when diene dewencies were or will be corrected. <br />G. Line Leak Detectors (LLD). a Check Otis bol < if LLDs are not installed. <br />n.,.....• .. .r._ •.M"—I— eks lrrt.f- <br />-- Yea A <br />Q No* <br />For equipment start-up or an.=u equipt oent cenifloadoo, was a kale simulated to verify LLD performance? <br />Q N/A <br />(Check all that apply) Simulated leak rate; ,W 3 g.p.h.; Q 0.1 g.p.h ; Q 0.2 g p.h. <br />O Yes <br />No* <br />Were all LLDs confirmed aperatiotssl and accurate within regulatory requirements? <br />Yes <br />Q No* <br />Was the testing apparatus preperiy calibru,ed? <br />O Yes <br />No* <br />For mechanical LLDs, does rtir J ' '? restrict product flour if it darts a icak? <br />O N/A <br />Q Yes <br />O 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 LUM, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />N/A <br />or disconnected? <br />O Yes <br />0 No* <br />For electronic LLDs, does the to bim autotnatically shut off if any portion of the monitoring system malfunctions <br />N/A <br />or fails a test? <br />O Yes <br />O No* <br />For electronic LLDs, have all accessible wiring connections been visually Inspected? <br />Jil- N/A <br />Yes <br />O No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />• In the Section H, below, describe hour and when uMae denclencM wen or win the correctea. <br />R. Comments:9-�4-� C�sD � J., <br />Page 3 of 3 <br />1l, <br />S/b'd M7289b:01 9U_T-T2S-602 JNIlS81'dW09'1Sn:wo�i 82:8T S002-BT-7nf <br />