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F. In-Tank Gauging/ SIR Equipment: L3Check this box if t gauging is used only for inventory control. <br /> ❑ Check this box if no tank gauging or SIR equipment is installed. <br /> BMs section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. <br /> F <br /> e the followin checklist:❑ No* Has all input wiring been inspected for proper entry and termination,.including testing for ground faults? <br /> ❑ No* Were all tank gauging probes visually inspected for damgo adid residue buildup? <br /> CT <br /> ❑ No* Was accuracy of system product level readings❑ No* Was accttracy of system water level r s tested? <br /> ❑ No* Were all probes reinstalled pr yT <br /> ❑ Yes ❑ No* Were all items on the rpment manufacturer's maintenance checklist completed? <br /> * In the Section H,below,descri ow and when these deficiencies were or will be corrected. <br /> G. Line Leak D ors (LLD): ❑ Check this box if LLDs are not installed. <br /> Com tete the followin checklist: <br /> es ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br /> ❑ N/A (Check all that apply) Simulated leak rate: J�g.p.h.; ❑ 0.1 g.p.h; ❑0.2 g.p.h. <br /> Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> Y.rYas ❑ No* Was the testing apparatus properly calibrated? <br /> es ❑ No* For mechanical LLDs,does the LLD restrict product now 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 <br /> ❑ N/A or disconnected? <br /> ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br /> ❑ N/A malfunctions or fails a test? <br /> ❑ Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? <br /> ❑ N/A <br /> es ❑ 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 /> Testing Company Name: TANK-TEK ENVIRONIv�E�ITAL CORPORATION Phone No.: (707) 446-6151 <br /> Site Address: Date of Testing/Servicing:f"_C <br /> Page 3 of 3 03/01 <br />