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gulg/ 'NllZEguiPm <br /> Check this box if tank gai 'a used only for invento <br /> ❑ Check this box if no tank g�n <br /> This section must be g or SIR r'control. <br /> mpleted if in au equipment is installed. <br /> co tete g a�g�ItuPment is used to perform <br /> the followin checklist leak detection <br /> ❑ Yes ❑ No* monitoring. <br /> ❑ Yes Has mpnt a 1rmS been ins 100.111 <br /> C <br /> ❑ No* Were all petted for proper 1*ate'I!ll <�-- <br /> ❑ Yes ❑ No* tank gauging Probes visually' d for dame 04 C <br /> tion,including testing for ground ? 37C t <br /> Was accuracy of system product lev ge and residue buildup? <br /> ❑ Yes ❑ Nn* Was accuracy of system water <br /> ❑ Yes dings tested? <br /> ❑ No* Were all el readings tested? <br /> ❑ Yes ❑ No* Probes reinstall roperly? <br /> Were all items on equipment manufa <br /> *In the Section$,below,describ cturer's maintenance checklist completed? <br /> ow and when these deficiencies were or will be corrected, <br /> G. Line Leak Detectors <br /> (LLD): <br /> Com Mete ❑ Check this box if LLDs are not installed. <br /> the follow' checklist: <br /> Yes ❑ No* <br /> For e <br /> ❑ N/A quipment start-up or annual <br /> (Check all that apply) Simulatedleakat, �3 rtlfication was a leak simulated <br /> 'Yes ❑ No* Were g•P.h.; ❑0.1 g.P.h; ❑0.2 g.p.h to verify LLD performance? <br /> Yes LLDs confirmed operational and act <br /> ❑ No* within re <br /> ❑ Yes ❑ No* Was the testing apparatus Properly calibrated7 gulatoryrequirements7 <br /> For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br /> e'N/A <br /> Yes ❑ No* For electronic LLDs,does the turbine automatically shut off"the❑ N/A <br /> &r Yes ❑ No* LLD detects a leak? <br /> For electronic LLDs, does the turbine auto <br /> ❑ N/A or disconnected? automatically shut off if an <br /> WYes ❑ No* Y Portion of the monitoring system is disabled <br /> For electronic LLDs,does the turbine auto <br /> ❑ N/A or fails a test? matically shut off if an <br /> Yes ❑ No* Y Portion of the monitoring system malfunctions <br /> For electronic LLDs,have all accessible whin <br /> ❑ N/A g connections been <br /> Yes ❑ No* Were all items on the equipment manufa vncually inspected? <br />*In the secfion cturer's maintenance checklist completed? <br /> below describe Low and when these deficiencies were or will be corrected, <br /> H. Comments: <br /> Page 3 of 3 <br /> 03/01 <br />