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C <br />F. In -Tank Gauging / SIR Equipment: <br />Q Check this box if tank gauging is used only for inventory control. <br />O Check this box if no tank gauging or Slit equipment is installed. <br />This section must be completed if in -tank gauging equipment is used to perform Ieak detection monitoring. <br />CmmnlPto tho Fnitn-4— <br />* to the Section H, below, describe haw and when these deficiencies were or will be corrected. <br />G. Line Leak Detectors (LLD): <br />rnmrifintP the Fnitnwina ohPPlrllct• <br />Check this box if LLDs are not installed. <br />0 Yes <br />❑ No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />❑ No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />VEIYes <br />❑ No* <br />Was accuracy of system product level readings tested? <br />Yes <br />❑ No* <br />Was accuracy of system water level readings tested? <br />❑ Yes <br />O No* <br />Were all probes reinstalled properly? <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* to the Section H, below, describe haw and when these deficiencies were or will be corrected. <br />G. Line Leak Detectors (LLD): <br />rnmrifintP the Fnitnwina ohPPlrllct• <br />Check this box if LLDs are not installed. <br />0 Yes <br />❑ No* <br />For equipment start-up or annual equipment crtification, was a leak simulated to verify LLD performance? <br />❑ N/A <br />(Check all that apply) Simulated leak rate: C! 3 g.p.h.; ❑ O. i g.p.h ; O 4.2 g.p.h. <br />Yes <br />❑ No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />Yes <br />❑ No* <br />Was the testing apparatus properly calibrated? <br />❑ Yes <br />❑ No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />❑ N/A <br />Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />❑ N/A <br />or disconnected? <br />es <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions <br />❑ N/A <br />or fails a test? <br />Q -Yes <br />❑ No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />❑ N/A <br />Ef Yes 1 <br />❑ No* <br />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 />D. Comments: 0,4 1 C r=; Ak <br />0 <br />7 - <br />okl <br />Page 3 of 3 ON01 <br />