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Site Address: 2 Fre.rr f -- �� L�Y�, e of Testing/Servicing: F. In-Tank Gauging/SIR Equipment: Check this box if tank gauging is used only for inventory control. ❑ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform Icak detection monitoring. Co p gte,the following checklist: Yes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? Yes I No* Were all tank gauging probes visually inspected for damage and residue buildup? Yes I P No* I Was accuracy of system product level readings tested? IJT Yes I ❑ No* I Was accuracy of system water level readings tested? Yes ❑ No* Were all probes reinstalled properly? es ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. C mplete the following checklist: I Yes I ❑ No* For equipment start-up or annual equipmen�t/certification, was a leak simulated to verify LLD performance? ❑ N/A (Cleck all that apply) Simulated leak rate: [�3 g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. M.V_XYes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? Yes El No* Was the testing apparatus properly calibrated? 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? I IV N/A ❑ Yes No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled N/A or disconnected? ❑ Yes No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system N/A malfunctions or fails a test? ❑ Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? 11 N/A Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: