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RECEIVED <br /> F.In-Tank Gauging/SIR Equipment: W Check this box if tank gauging is used only for inveMMq{trZL 14 i <br /> r Check this box if no tank gauging or SIR equipment is <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> Complete the following checklist: <br /> YesjNo- Mwiringut wiring been inspected for proper entry and termination, including testing for ground faults? <br /> Yesnk gauging probes visually inspected for damage and residue buildup? <br /> Yescy of system product level readings tested? <br /> Yescy of system water level readings tested? <br /> Yesrobes reinstalled properly?Yesms on the equipment manufacturers 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): r 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?(Check al/that <br /> apply)Simulated leak rate:�3 g.p.h.; r 0.1 g.p.h; �0.2 g.p.h. <br /> N/A <br /> • Yes No* ere all LLDs confirmed operational and accurate within regulatory requirements? <br /> • Yes No* as the testing apparatus properly calibrated? <br /> • Yes �' No* 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 automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> • N/A <br /> Yes No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> 1: N/A <br /> Yes No* For electronic LLDs, have all accessible wiring connections been visually inspected? <br /> • N/A <br /> • Yes No* ere all items on the equipment manufacturers maintenance checklist completed? <br /> *In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> Page 3 of 3 12/07 <br />