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SiteAddress:jCYgj" :5 lye+ r/ /df'4�/-T / rtllp I Ut{ L2 (r7' V f�� Date of Testing/Servicing: F. In-Tank Gauging/SIR Equipz,fent: M-17beck this box if tank gauging is used only for inventory control. ❑ 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: HEJYes KNo* s all input wiring been inspected for proper entry and termination, including testing for ground faults? re all tank gauging probes visually inspected for damage and residues accuracy of system product level readings tested? s accuracy of system water level readings tested? re all probes reinstalled properly? re 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. Com etc the following checklist: Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? ❑ N/A (Check a!!that apply) Simulated leak rate: �p.h.; ❑ 0.1 g.p.h ; ❑ 02 g.p.h. O'Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? Y ❑ No* Was the testing apparatus properly calibratede Yes ❑ No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? Cd N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled L')JN/A or disconnected? ❑ Yes ❑Vo* For electronicLLDs, does the turbine automatically shut off if any portion of the monitoring system L N/A malfunctions or fails a test? ❑ Yes ❑ o* For electronic LLDs, have all accessible wiring connections been visually inspected? ❑ N/A Ij Yes ❑ No* Were 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. H. Comments: