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Site Address: <br />F. In -Tank Gauging / SIR Equipment: <br />Date of Testing/Servicing: <br />❑ Check this box if tank ganging is used only for i;rventori control. <br />❑ Check this box if no tank gauging or SIR equipment is installed. <br />This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. <br />C fete the Nil ing checklist: <br />Q No* Has all input wiring been inspected for proper entryand termination, including testing for ground faults? <br />es ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br />❑ No Was accuracy of system product level readings tested? <br />❑ No* Was accuracy of system water level readings tested? <br />❑ No* Were all probes reinstalled properly'? <br />Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist, completed? <br />* In the Section H, below, describe haw and when these deficiencies were or will be corrected. <br />G. Line Leak Detectors (LLD): <br />ramurete the. fnllawinQ checklist <br />❑ Check this box if LLDs are not installed <br />es <br />❑ No* <br />For equipment startup or annual ewpinent cejiffication, was a leak simulated to verify LLD performance? <br />u N/A <br />(Creek all that app Simataied leak rate: g.p.h.�; ❑ 0-1 g.mh.z; ❑ 0.2 o.P.h.z <br />Notes: 1. Required for equipment start-up certification and annual certification. <br />2. Unless mandated by Iocal agency. certification required only for electronic LLD start-up. <br />Y <br />❑ No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />❑ No* <br />Was the testing apparatus properly calibrated? <br />Yes <br />❑ No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />Q N/A <br />❑ Yes <br />❑ Flo* <br />For electronic LLDs, does the turbine antomatically shut off if the LLD detects a leak? <br />galIN/A <br />p Yes <br />❑ Ilio* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />i7i N/A <br />or disconnected? <br />❑ Yes <br />❑ Ne <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br />N/A <br />malfunctions or fails a tese <br />❑ Yes <br />Q o* <br />EN/A <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />Yes <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In the Section H, below, describe how and when these deficiencies were or wui ne corrmww <br />H. Comments: <br />Page 3 of 03101 <br />