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,Site Address: C of Testing/Servicing: <br /> 1 <br /> F. In-Tank Gauging/ S[R Equipment: Cl Check this box if tank gauging is used only for inventory control. <br /> ❑ Check this box if no tank gauging or SIR equipment is installed. <br /> This section must be completed if in-lank 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): ❑ Check this box if LLDs are not ins.alied. <br /> Com tete the following checklist: I <br /> Yes ❑ No* For equipment start-up or annual equipment ccee.ti€ication, was a leak simulated to verify LLD performance? <br /> ❑ N/A (Check all that apple) Simulated leak rate: Q 3 g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. <br /> J Yes No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> Yes ❑ No* Was the testing apparatus properly calibrated? <br /> 3 Yes ❑Flo* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br /> �N/A <br /> I Yes O,-No* I For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br /> ❑ N/A <br /> I Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> L] N/A or disconnected? <br /> I Yes 1 ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br /> E3N/A malfunctions or fails a test? <br /> Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? <br /> ❑ N/A <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 /> . Comments: k,72 rP42 <br /> v� �rt c� 1�'MfG C ✓.� �r < lZ �pt� <br />