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Site Address: �o H RJ �2'' a pl +64 Ale' La�C1d r" <br />to of Testing/Servicing: D7 /?_D kilo <br />'F. In -Tank Gauging / SIR Equipment:,/ <br />�T Check this box if tank gauging is used only for inventory control. <br />❑ Check this bo •f <br />rx i no tank "aUg"Ing or SIR equipment is installed. <br />This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. <br />Complete the following checklist: <br />❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br />❑ Yes ❑ No* Was accuracy of system product level readings tested? <br />❑ Yes ❑ No* Was accuracy of system water level readings tested? <br />❑ Yes ❑ 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 how and when these deficiencies were or will be corrected. <br />G. Line Leak Detectors (LLD): ❑ Clreck this box if LLDs are not installed. <br />Co tete the following checklist: I <br />Yes ❑ No* For equipment start-up or annual equipments tification, was a leak simulated to verify LLD performance? <br />❑ N/A (Check all Mal apply) Simulated leak rate:] 3 g.p.h•; ❑ 0.1 g.p•h ; ❑ 0.2 g.p.h. <br />es ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br />es ❑ No* Was the testing apparatus properly calibrated? - <br />�! Yes ❑ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ N/A <br />Yes❑ o* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ✓ �� �o� r4~ <br />I Yes EI bio* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />Zf N/A or disconnected? <br />Yes ❑ No* For electronic LLDs, does (lie turbine automatically shut off if any portion of the monitoring system <br />,EJ'N/A malfunctions or fails a test? <br />Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? <br />j 21"N/A <br />Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br />n the Section H, below, describe Iroiv and �vlren these deficiencies �vcre or will be corrected. <br />Comments: M-P4D <br />