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F.In-Tank Gauging/SIR Equipment: r Check this box if tank gauging is used only fo I I <br /> ❑Check this box if no tank gauging or SIR equipi ed. F I ■/E[); <br /> This section must be completed if In-tank gauging equipment is used to perform leak detection monitoring. MAY <br /> FIVE[), <br /> Complete the following checklist: MAY Q 7 2015 <br /> r Yes ! No* Has all input wiring been inspected for proper entry and termination,Including testing for ground faul _ ENTAL. <br /> • Yes Ir No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> - -rr,pr_r�r— <br /> r Yes r No* Nas accuracy of system product level readings tested? <br /> ryes r No* Nas accuracy of system water level readings tested? <br /> r Yes r No* Nere all probes reinstalled properly? <br /> Yes r No* Nere all items on the equipment manufacturer's maintenance checklist completed? <br /> *In the Section H,below,describe how and when these defciencies were or will be corrected. <br /> G.Line Leak Detectors(LLD): n Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> Yes No* For equipment start-up or annual equipment certification.rr,,was a leak simulated to verify LLD performance?(Check all that <br /> r rN/A apply)Simulated leak rate:�Y.�l 3 g.p.h.; ❑ ,, <br /> 0.1 g.p.h; L10.2 g.p.h. <br /> Yes r No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> Yes + No* Was the testing apparatus properly calibrated? <br /> Yes No* For mechanical LLDs,does the LLD restrict product now if it detects a leak? <br /> (� N/A <br /> ro 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 that are programmed for positive shut down,does the turbine automatically shut off if any portion of the <br /> r N/A <br /> For <br /> system is disabled or disconnected? <br /> F. Yes rNo* For electronic LLDs that are programmed for positive shut down,does the turbine automatically shut off If any portion of the <br /> N/A <br /> moniroring system malfunctions or fails a test? <br /> Yes r No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> r No <br /> Yes I No* ere all items on the equipment manufacturer's maintenance checklist completed? <br /> 7-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 />