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Site Address: F. 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. Complete the following checklist: * In the Section H, 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 D 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? EJ Yes ❑ No* Was accuracy of system product level readings tested? Yes ❑ No* Was accuracy of system water level readings tested? Yes ❑ No* Were all probes reinstalled properly? =Yes 1 ❑ No* 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. 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? ❑ N/A (Check all that apply) Simulated leak rate: ❑ 3 g.p.h.1; ❑ 0.1 g.p.h.2; ❑ 0.2 g. p. h.2 Notes: 1. Required for equipment start-up certification and annual certification. 2. Unless mandated by local agency, certification required only for electronic LLD start-up. es ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? Yes ❑ No* Was the testing apparatus properly calibrated? ❑ Yes ❑�10* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? D N/A Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑ N/A bl-Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled i ❑ NIA or disconnected? p'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? EY Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? ❑ N/A lyes ❑ No* 1 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. H. Comments: Page 3 of 3 03/01