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Site Address: <br /> Date oF'i'esting/Servicing: <br /> �. F. In-Tank Gauging/SIR Eq ui pmettt: 121 Check this box if tank gauging is used only for inventory control. <br /> ❑ Check this box if no tank ganging or SIR equipment is installed. <br /> This section must be completed if in-lank gauging equipment is used to perform leak detection monitoring. <br /> Complete the following checklist: <br /> ❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br /> ❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ❑ Yes ❑ No* Was accuracy of system product level readings tested? <br /> ❑ Yes ❑ No* Was accuracy of system water level readings tested? <br /> ❑ Yes ❑ No* Were all probes reinstalled properly? <br /> ❑ Yes ❑ p1o* Were all items on the equipment manufactur'er'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): ❑ Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> ❑ Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br /> ❑ N/A (Check all that 1y) Simulated leak rate:appEl <br /> g.p.h.; [30.1 g.p.h ; 13 0.2 g.p.h. <br /> 13 Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> ❑ Yes ❑ No* Was the testing apparatus properly calibrated? <br /> ❑ Yes ❑ Ni * 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, does the turbine <br /> ❑ N/A or disconnected? automatically shut off if any portion of the monitoring system is disabled <br /> ❑ Yes ❑ No* For electronic LLDs, does ll;e turbine automat <br /> [I Nalfunctions or fails a test? ically shut off if any portion of the monitoring system <br /> /A m <br /> ❑ Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? <br /> ❑ N/A <br /> ❑ Yes ❑ No* Were 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 /> H. Comments: /_ fi el,- <br /> c 0 Pill 10 Cm <br />