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Site Address: Date ofTesdugr;euvicing: F. In-Tank Gauging/$II2 Equipment: ❑ Check this box if tan- gauging is used only-for irrventory corruat. ❑ Check this box if no tank,gauging or SIR equipment is installed" This section must be completed if in-tank gAli.��egtapnPert is used to perform leak detection monitoring. Complete the following checklist ❑ T Has all input wiring been" for g g ground faults? wed Pte— a=te lir=atiorL including testing for ❑ Yes ❑ No* Wer - ' g probes visually inspected for damage and residue buildup? ❑ Yes ❑ No* Was accuracy of system p dings tested? ❑ Yes ❑ No* Was accuracy of system mater level readings test l ❑ Yes ❑ No* Were all probes reinstalled properly? ❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance che&hst completed? In the Section H,below, describe how and when these deficiencies were orwill be corrected- G. Line Least Detectors (LLD): 2"theck this box if LLDs are Lot in,LecL Complete the following checklist: es ❑ No* For equipment start-up or annual equipment certification- was a Ieak simulated to verify LLD perforn N/A_ (Check all that apply) Simulated leak rale_ ❑:a.p-h_'- ❑0.1 a p.h-''- ❑02 &p-h-2 Notes: 1. Required for equipment st<st-ap certificati-o3 z-d ar=�—j cert=5c;tion_ ! 2. Unless mandated by local apency.certificatioa required only fc)r elcciLp is LID stmt-up. � ❑ Yes ❑ No* Were aftLQs confirmed operational and accurate Within regulatory rertuirements? ❑ Yes ❑ Nom Was the testing ap tus properly cahbraied? ❑ Yes ❑ No* For mechanical LL Ds doe LLD rasirict product flois,if it detects a leaf? ❑ N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine auto shui of if the LLD detects a leak? ❑ N/A ❑ Yes ❑ No= For electronic LLDs, does the turbine automaticaily shut e_ ' a y portion•of the moruto.ing syste_n is di-bled I ❑ N/A or disconnected`? ❑ Yes ❑ No* For electronic LLDs. does the turbine automatically shut off if any on of the mortiPoring syste ❑ N/A malfunctions or fails a test? ❑ Yes ❑ No* For electronic LLDs,have all accesis�-ble vv-irina connections been ti,risuall iuspted? ❑ N/A i ❑ Yes ❑ No* Were all items on the equipment manuf2cim-er's maiintenance checklist completed? In the Section€l, below,describe how and when these deficiencies were or will he corrected. IBI. Comments. Page 3 of 3 Q3101