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F. In -Tank Gauging / SIR Equipment: r Check this box if tank gauging is used only for inventory control. P 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: f Yes No* las all input wiring been inspected for proper entry and termination, including testing for ground faults? r Yes No* Nere all tank gauging probes visually inspected for damage and residue buildup? Yes No* Nas accuracy of system product level readings tested? r Yes No* Nas accuracy of system water level readings tested? Yes No* Nere all probes reinstalled properly? Yes No* Nere 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): Check this box if LLDs are not installed. Complete the following checklist: ENVIRONMENTAL HEALTH DEPARTiM.ENT r Yes r No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? Simulated leak rate: r 3 g.p.h.; r 0.1 g.p.h; r 0.2 g.p.h. N/A Yes r No* Were all LLDs confirmed operational and accurate within regulatory requirements? f Yes r No* Was the testing apparatus properly calibrated? Yes r No* For mechanical LLDs, does the LLD restrict product Flow if it detects a leak? N/A Yes No. r electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? N/A •' Yes No* ror electronic LLDs that are programmed for positive shut down, does the turbine automatically shut off if any portion of the onitoring system is disabled or disconnected? N/A •Yes No* r electronic LLDs that are programmed for positive shut down, does the turbine automatically shut off if any portion of the onitoring system malfunctions or fails a test? N/A • Yes No* or electronic LLDs, have all accessible wiring connections been visually inspected? N/A r Yes r No* Nere 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. Page 3 of 3 12/07