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07/21/2008 15:41 FAX 10004 <br /> Eel a e(Aluck Lfii.%Fox ii.Lank gml.lin;: i;;tiW11.only)�)r M <br /> .1 L_ <br /> Chuck this box Win)JLInk L;)k)-' f <br /> �11114 <br /> section must be completed if in-tank gauging equipment is used to <br /> C2!R!!!Ae the Following checklist: peribrIll leak detection nj()jjitOrjjjV,. <br /> ❑ Yes 7NO I_j_.Lajj input <br /> ng been inspected for proper entry and ic <br /> rmination, 1FICluding testing tbr <br /> l round faultv <br /> residue buildup'? <br /> Ed-'yas ❑ No* Were III taiTgauguig pr �b­e4vjsuTjy_j_nSpt�ctL;d for ag,�an_d <br /> U Y11 0 No Was accuracy ofsy.,Nem—prodildt—1vvelreadj118's <br /> tested?— <br /> C) Yes Q No* Was_accutuq_jA system water level readings tested't <br /> Cl Yes ❑ N& Were all probes reinstalled properly? <br /> Lj Yes ❑ No* Wencall items—----- <br /> on the equipment IllanUfacturWs mmhlte'71a�e checklist cor- <br /> 11 Tlpletedq <br /> *Inthe s . ion H, below,deZribe how�and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors (UI)); Ll Check this box if 1.11)s are not <br /> I installed. <br /> 0 tete e 0 Ow III <br /> ff�c( the 111 11 1 <br /> '"""�Inl <br /> Yes 13 �0* For checklist: <br /> Start-up or annual equipment certifjcari <br /> [1 N/A on, was a ea' simulated to verify <br /> Peck'111 ghat aPPIY) Simulated leak rate: V3 g.p-h.; Q 0.1 g.p.h 0.2 g,p.11. LLD pLrforrilance? <br /> Yes O NO* Were all L1,Ds confirmed operational and accui-aw-W—Whin re9 <br /> Yes 0 No* ttlatOry requirements?Was the testing app,,,ml,nrnn,-rl,,calibratetl7 --————— <br /> Yes El No* Far mecFtwical 1.11)5,does the LI.D restri. <br /> (3 N/A ct product flow if it detects a leak? <br /> U yes Q NO For <br /> ..JX1TQIJIC LLUS,does the turbine automatically on <br /> Ljj <br /> NIA it the LLD detects,leak? <br /> Q yes 0 No* For eMIZLTOMC LLUS, does the turbine autnou".1-1V-,JUL Oir 11 any Portion of the <br /> X NIA or disconnected'? monitoring system is disabled <br /> Lj Yes 0 No* Fur electronic LLD9,does UM turbine automatically shut off if any portion of the monitoring system malfunctions <br /> ed N/A or faits a test? <br /> U Yes C3 No* F <br /> A wiring cormections been visually inspected? <br /> Yes Q No Were all item.,on the equipment manufacturer's maintenance checklist completed? <br /> In the Section H,below,dMerilbe how a <br /> nd when these deficiencies were or will be corrected. <br /> H. Comillents: <br /> Page 3 of 3 <br />