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F_ <br />] <br />0 <br />F. In -Tank Gauging / SIR Equipment: r Check this box if tank gauging is used only for inventory control. <br />r Check this box if no tank gauging or SIR equipment is installed. <br />This section must be completed if in -tank gauging equipment is us to perform leak detection monitoring. <br />Complete the following checklist: <br />Yes <br />r NO <br />Has all input wiring been inspectec <br />for proper entry and termination, including testing for ground faults? FFR 9 <br />r Yes <br />r No* <br />Were all tank gauging probes visuc <br />Ily inspected for damage and residue buildup? <br />T Yes <br />r No* <br />Was accuracy of system product le <br />el readings tested? <br />r Yes <br />r No* <br />Was accuracy of system water leve <br />readings tested? <br />r Yes <br />r No* <br />Were all probes reinstalled properly? <br />- <br />(: Yes <br />r No* <br />Were all items on the equipment m <br />nufacturer's maintenance checklist completed? <br />* In the Section H, below, describe how and when these deficiench s 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 <br />(' No* <br />For equipment start-up or annual a <br />app/y) Simulated leak rater 3 g..h.; <br />uipment certification was a leak simulated to verify LLD performance? (Check all that <br />r 0.1 g.p.h; Ii 0.2 g.p.h. <br />r N/A <br />(.• Yes <br />r No* <br />Were all LLDs confirmed operational <br />and accurate within regulatory requirements? <br />r Yes <br />r No* <br />Was the testing apparatus properly <br />calibrated? <br />r Yes <br />(' No* <br />For mechanical LLDs, does the LLD <br />restrict product Flow if it detects a leak? <br />r N/A <br />t Yes <br />(' No* <br />For electronic LLDs, does the turbine <br />automatically shut off if the LLD detects a leak? <br />r N/A <br />IT Yes <br />r No* <br />For electronic LLDs that are progra <br />road for positive shut down, does the turbine automatically shut off if any portion of the <br />r N/A <br />monitoring system is disabled or disconnected? <br />r Yes <br />r No* <br />For electronic LLDs that are progra <br />umed for positive shut down, does the turbine automatically shut off if any portion of the <br />r N/A <br />monitoring system malfunctions or I <br />ails a test? <br />IT Yes <br />r No* <br />For electronic LLDs, have all accesE <br />able wiring connections been visually Inspected? <br />r N/A <br />r Yes <br />r No* <br />Were all items on the equipment in <br />inufacturers maintenance checklist completed? <br />* In the Section H, below, describe how and when these defclenci s were or will be corrected. <br />Page 3 of 3 12/07 <br />2 2016 <br />!MENTAL <br />PARTAAFNT <br />