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Sep 28 02 02:38p P.5 <br />F. In -Tank Gauging 1 SIR Equipment: check this box if tank gauging is used only for inventory control. <br />O Check this box if no tank gauging or SM equipment is installed. <br />This section.must be completed if in -tank gauging equipment is used to perform leak detection monitoring. <br />Cadnmlete the followinE checklist: _ <br />* In the Section H, beiow, oesenue now ana when nurse ucxAurAAe acs ..4. � ..• ...w w . +.. - <br />G. Lute Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. <br />4-0 Y 16Le LA1r AUAAU <br />❑ No* <br />Has all input wiring been inspected for proper entry and termination, lncluarmg iesrmg 'Or grousuu rauLL3 r <br />Yes <br />❑ No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />es <br />❑ No* <br />Was accuracy of system product level readings tested? <br />Eyes <br />O No* <br />Was accuracy of system water level readings tested? <br />❑ Yes <br />O No* <br />Were all probes reinstalled properly?. <br />❑ Yes <br />Q No* <br />Were all items on the equipmentmmanufacuaw s maintenance checklist completed? <br />* In the Section H, beiow, oesenue now ana when nurse ucxAurAAe acs ..4. � ..• ...w w . +.. - <br />G. Lute Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. <br />4-0 Y 16Le LA1r AUAAU <br />AMr, WAra. 4 - <br />For equipment start-up or annual equipment 6tification, was a Ieak simulated to verify LLD performance? <br />(Check all that apply) Simulated leak rate: 3 g.p.h.; ❑ 0.1 gp.h ; ❑ 02 gp.h. <br />Yes ❑ No* <br />Q NIA <br />Yes <br />O No* <br />Were all LLDs confirmed operational and accurate within. regulatory regdxemeuts? - <br />es <br />0 No* <br />Was the testing apparatus properly calibrated? <br />Yes <br />❑ No* <br />❑ N/A <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ Yes <br />o* <br />r/A <br />For electronic LLDs, does the turbine automatically shut off"if the LLD detects a leak? <br />❑ Yes <br />❑, qo* <br />& N/A <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />or disconnected? <br />❑ Yes <br />® o* <br />N/A <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system roaffimctions <br />or fails a test? <br />Vy-r.ZYes <br />C2 o* <br />N/A <br />For electronic LLDs, have all acccssible wiring connections been visually inspected? <br />O No*I <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 wM be correcrea. <br />Iti s1�,rr•i►. <br />Page 3 of 3 03101 <br />