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F. In -Tank Gauging / SIR Equipment: heck this box if tank gauging is used only for inventory control. <br />❑ Check this box if no tank gauging or SIR equipment is installed. <br />This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. <br />Complete the following checklist: <br />❑ <br />Yes <br />Q No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />❑ <br />Yes <br />❑ No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />❑ <br />Yes <br />❑ No* <br />Was accuracy of system product level readings tested? <br />❑ <br />Yes <br />❑ No* <br />Was accuracy of system water level readings tested? <br />❑ <br />Yes <br />I Q_N­o­*r <br />Were all probes reinstalled properly? <br />❑ <br />Yes <br />1 ❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In the Section H, <br />below, describe how and when these deficiencies were or will be corrected. <br />G. Line Leak Detectors (LLD): heck this box if LLDs are not installed. <br />Complete the following checklist: <br />❑ Yes ❑ No* For equipment start-up or annual equipment certification, was a Ieak simulated to verify LLD performance? <br />❑ N/A (Check all that apply) Simulated leak rate: ❑ 3 g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. <br />❑ Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br />❑ Yes ❑ No* Was the testing apparatus properly calibrated? <br />❑ Yes ❑ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ N/A <br />❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />❑ N/A <br />❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />❑ N/A or disconnected? <br />❑ Yes ff No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br />❑ N/A malfunctions or fails a test? <br />❑ Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? <br />❑ N/A <br />L(37Y7es ❑ No* 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 />H. Comments: G ` sr <br />® � L <br />d <br />Page 3 of 3 <br />03101 <br />EM <br />