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,05/03/2007 09:40 2099519352 VILLAGE 1AEST MARINA PAGE 04 <br />In -Tank Gauging / SIR Equipment: <br />❑Check this box if tank gauging is used only for inventory control and disregard the following section. <br />[RCheck this box if no tank gauging or SIR equipment is installed and disregard the following section. <br />--` (This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring). <br />Tom late the following eheciWat: <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 />❑ qYes <br />❑ No* Were all probes reinstalled properly?❑ Ll No* Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In the Section H, below, describe how and when these dei9ekoaim were or well be corrected. <br />G. Line Leak Detectors (LLD): <br />❑ Check this box if LLDs are not installed and disregard the following section.. <br />® Yes or annual equipment certification, was a leak simulated to verify LLD performance? <br />Simulated leak rate: 0 3 g.p.h.; [10. 1 g.p.h ; ❑ 0.2 g.p-h, <br />rmed operational and accurate within regulatory requirements? <br />properly calibrated? <br />does the LLD restrict product flow if it detects a leak? <br />does the turbine automatically shut off if the LLD detects a leak? <br />does the turbine automatically shut off if any portion of the monitoring system is disabled <br />Ds, does the turbine automatically shut off if any portion of the monitoring system <br />s a test? <br />❑ No* <br />For equipment start -up <br />❑ N/A <br />y) <br />(Check all that app! <br />yes <br />❑ No* <br />Were all LLDs conf, <br />Was the testing ap paratus <br />® YTEI <br />Y <br />For mechanical LL Ds, <br />For electronic LLDs <br />❑ Y <br />For electronic LL Ds, <br />❑ Yes <br />❑ No* <br />® N/A <br />or disconnected? <br />For electronic LL <br />❑ Yes <br />❑ No* <br />® N/A <br />malfunctions or fail <br />❑ No* <br />LLDs <br />For electronic LLDN/A <br />[[:ILYes <br />No" <br />Were all items on <br />have all accessible wiring connections been visually inspected? <br />the equipment manufacturer's maintenance checklist completed? <br />* Io the Section H. below, describe how and when these defieieneies were or wiH be corrected. <br />D. Comments: None. <br />Page 3 of 3 <br />03i I <br />