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12/11/2008 12:19 FAX -► SJEH 1@003 <br /> F. In-Tat11(Ganging/tilt Equipment: ❑ Check this box if lank gauging is used only for inventory control. <br /> ❑ Chcck this box if no tnuk gaugitit;or SIR c:quipnrent is inst7161. <br /> This section must be compacted if In-tanlC gauging equipment is used to perform leak detection monitUl'iitg. <br /> Coni Mete the fot!7win 'checldist: _ <br /> U Yes U No* Has all input wiring heen inspected for proper entry and termination, including testing for ground faults? _ <br /> U Yes U No* Werc all tank gauging probes viscidly inspected for damage rind residue buildup? <br /> ❑ Yes ❑ Nu* Wits accuracy ol'system product level readings tested? M <br /> ❑ Yes ❑ Nu* Wits accuracy ursystem water level readings tested'! r. <br /> 0 Yes Q Nu¢ Werc all probes reiuslalled properly'! <br /> 0 Yes Q NO Were all items oil the equipment manufacturer's maintenance checklist completed? <br /> k it the:Section 11,below,describe haw and when these deticicneia were or will he corrected. <br /> C. Tine [,cats Detectors (LLD): ❑ Check this box if I.A.Ds are not installed. <br /> Comp] the rullo ing checklist: _ <br /> U Yes ❑ No* For equipuretit start-up or annual equipment Certification, was a leak simulated to verify LLD perlbrmance? <br /> Q N/A (Check u//that app/v) Simulated leak rete: ❑3 g.p.h.; ❑0.1 g.p.h; ❑0.2 g.p.h. <br /> Q Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory re(iuiremcnls? <br /> ❑ Yes ❑ No* Was the testing apparatus properly calibrated? <br /> is Yes ❑ No* For mechanical LLL)s,does the LLD restrict product flow if it detects it leak? <br /> ❑ N/A <br /> ❑ Yes Q No-* For electroltic LLDs,does the turbine automatically shut off if the 1.113 detects a leak? <br /> ❑ N/A. <br /> U Yes U N60 For electronic I J,Ds,docs the turbine autoinalically shut off if any portion of the monitoring system is disabled <br /> U N/A or disconnected? <br /> ❑ Yes ❑ No* for electronic LLDs, does the turbine automatically shut off it' any portion of the monitoring system <br /> ❑ N/A malfunctions or fails u test? <br /> ❑ Yes ❑ No* For electronic LLDs,have all accessible wiring connections heen visually inspected? <br /> ❑ N/A <br /> U Yes U No* Were all items on the equipment niatiufacturcr's maintenance checklist completed? <br /> �.M <br /> In the Section H,below,describe how wad when these dericie.ncies were or will be corredrd, <br /> 1f. Cornnients: 5 <br /> Page 3 of3 <br />