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Site Address: E. In -Tank Gauging / SIR Equipment: Date of Testing/Servicing: ❑ Check this box if tank gauging is used only for inventory control. ❑ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. Co lett the following checklist_ ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? s ❑ No* Was accuracy of system product level readings tested? es ❑ No* Was accuracy of system water level readings tested? es ❑ No* Were all probes reinstalled properly? El"Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section l3, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): Complete the following checklist: ❑ Check this box if LLDs are not installed. ❑ Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? j ❑ NIA (Check all that apply) Simulated leak rate: ❑ 3 g.p.h.1; ❑ 0.1 g.p.h.'. ❑ 0.2 g.p.h.- Notes: 1. Required for equipment start-up certification and anmial certification. 2. Unless mandated by local agency, certification required only for electronic LLD start-up. ❑ Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? ❑ Yes 1 ❑ No* Was the testing apparatus properly calibrated? ❑ Yes ❑ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ N/A . ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LLDs_ does the turbine automatically shut off if any portion of the monitoring system is disabled ❑ N/A or disconnected? ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system ❑ N/A malfunctions or fails a test? ❑ Yes ❑ Ne For electronic LLDs, have all accessible wiring connections been visually inspected? ❑ N/A ❑ Yes ❑ No* I Were all items on the equipment manufacturer's maintenance checklist completed? = In the Section H, below, describe how and when these deficiencies were or will be corrected. M Comments: L 12 Ko % % PS' f cl /vU 12,z;,U1 S& c 4 e r c-<�, r%^ Page 3 of 3 Q3/Os