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RECEIVED F. In-Tank Gauging/SIR Equipment: JUN 14 2017 Q Check this box if tank gauging is used only for inventory control. ❑ Check this box if no tank gauging or SIR equFP#%W1RQkWaNTAL HEALTH DEPARTMENT This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Com lete the following checklist: aNo* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? No* Were all tank gauging probes visually inspected for damage and residue buildup? No* Was accuracy of system product level readings tested? No* Was accuracy of system water level readings tested? No* Were all probes reinstalled property? No* Were all items on the equipment manufacturer's maintenance checklist completed? *In the Section H,below,describe how andwhen these deficiencies were or will be corrected. G.Line Leak Detectors(LLD): ❑X Check this box if LLDs are not installed. Complete the following checklist: ❑Yes ❑No* For equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance?(Check ❑N/A all that apply)Simulated leak rate: ❑3 g.p.h.; ❑0.1 g p.h;❑0.2 g.p.h. ❑Yes ❑No* Were all LLDs confirmed operational and accurate within regulatory requirements? [:]Yes ❑No* Was the testing apparatus properly calibrated? ❑Yes ❑No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? ❑N/A ❑Yes ❑No* Forelectronic LLDs,does the turbine automatically shut off ifthe LLD detects a leak? ❑N/A ❑Yes ❑No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or ❑N/A disconnected? I❑Yes El No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or [:]N/A far Is a test? ❑Yes ❑No* Forelectronic LLDs, have all accessiblewiring connectionsbeen visually inspected? ❑N/A [:]Yes ❑No* Were all items on the equipment manufacturer's maintenance checklist completed? *In the Section H,below,describe how and when these de6eieneieswere or will be corrected. H. Com ments: