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Site Address: E. In -'Tank Gauging / SIR Equipment: Date of Tesdng/Servicing: ❑ Check this box if tank gauging is used only for inventory control. ❑ Check this box if no tank ;;auging or SIR equipment is installed. Pus section must be completed it in -tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: ©'Yes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults'? � D'Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? 4 M Yes ❑ No* Was accuracy of system product level readings tested? Q'Yes ❑ No* Was accuracy of system water level readings tested? ff Yes ❑ No* Were all probes reinstalled properly'? a Yes R ❑ No* I Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe bow and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): Complete the following checklist: ❑ Check this box if LLDs are not installed G�'Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? ❑ N/A iCheck all that apply) Simulated leak rate: 123 g.p.h.`:. ❑ 0.1 b.p.h.'; ❑ U.2 g.p.h.' Notes: 1. Required for equipment start-up certification and annual certification. I 2_ Unless mandated by local agency, certification required only for electronic LLD start-up. ❑'Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements'? I { 2 -Yes ❑ No* Was the testing apparatus properly calibrated? +12'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? Ip" WA ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled EY'N/A or disconnected? ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system ig—N/A malfunctions or fails a test'? ❑ Yes ❑ No* ' For electronic LLDs, have all accessible wiring connections been visually inspectedl a --N/A es Cl No* Were all items on the equipment manufacturer's maintenance checklist completed? I In the Section H, below, describe how and when these deficiencies were or will be corrected. M Comments: Page 3 of 3 13/01