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'In -Tank Gauging/ SIR Equipment: Check this box if tank is <br />gauging used only for inventory control. <br />❑ Check this box if no tank <br />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 />Com fete the following <br />checklist: <br />❑ Yes ❑ No* <br />❑ Yes ❑ No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />Were all tank gauging probes visually inspected <br />❑ Yes ❑ No* <br />for damage and residue buildup? <br />Was accuracy of system product level readings tested? <br />❑ Yes ❑ No* <br />Was accuracy of system water level readings tested? <br />❑ les ❑ No* <br />Were all probes reinstalled properly? <br />❑ Yes ❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist <br />completed? <br />* In the Section H below, describe how and when these deficiencies were or be <br />will corrected. <br />G. Line Leak Detectors (LLD): ❑ Check this box if LLDs <br />axe not installed. <br />Com Tete the foliowin checklist: <br />Yes ❑ No <br />El NIA <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD erforman? <br />pce <br />(Check all rhar apph�) Simulated leaf: rate: � 3 El0.1 <br />g.p•h., g. <br />Yes ❑ No* <br />Yes ❑ No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />>M <br />Was the testing appazatus property calibrated? <br />Yes ❑ No* <br />❑ NIA <br />For mechanical LLDs, does the LLD restrict product fl ow if it detects a leak? <br />❑ Yes ❑ No* <br />J� N/A <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />❑ Yes ❑ No* <br />f d N/A <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />or disconnected? <br />❑ YeS No* <br />For electronic LLDs, does the turbine autornaucally shut off if <br />�QCy <br />NIA <br />or fails a test? any portion of the monitoring system malfunctions <br />❑ Yes ❑ No* <br />For electronic LLDs, have all accessible wiring <br />A NIA <br />connections been visually inspected? <br />Yes ❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist <br />In the Section H, <br />completed? <br />below, describe how and when these deficiencies were or will be <br />corrected. <br />H. Comments: <br />Page 3 of 3 <br />03101 <br />