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Mata 05 04 03: 21p • (2091 749-0112 p. 4 <br /> • Site Address: 7v <br /> r i l �4 rJ r /,yr �,.ty ���� i•I}^Q (� 4 Dafc of rl'eslin Scrvicin t <br /> g; g: <br /> F. In-Tank Gauging/SIR Equipment: @-CFcck this bole if tank gauging is used only for inventory cot 1 I. <br /> U Check this box if no tank gauging or SIR equipment is instal <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 1 M No* Has all input wiring been inspected for proper entry and temtination, including testing for ground faults? <br /> ❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> O Yes O Now Was accuracy of system product level readings tested? <br /> ❑ Yes ❑ No* Was accuracy of system water level readings tested? <br /> ❑ Yes ❑ No* Wetc all probes reinstalled properly'.! <br /> ❑ Yes CI No* I Were all items on the equipment manufacturer's maintenance checklist completed? <br /> * In the Section H,below,describe how and when fhese 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 /> W'Ves ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD perfotman <br /> ❑ N/A (Check all that app/y) Simulated leak rate: a'T�gp•h.: ❑0.f g.p.h; ❑0.2 g.p.b. <br /> Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> YLJNo* Was 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 /> Q"111/A <br /> 0 Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if any portion or the monitoring system is disabl <br /> t-N/A or disconnected? <br /> ❑ Yes ❑ No* For electronic LLDs, does file turbine automatically shut off if any portion of the monitoring syste i <br /> Cf N/A malfunctions or fails a test? <br /> ❑ Yes ❑ * 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- <br /> Page 3 of 3 5la0 <br />