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e Site Address:�k <br />qw— <br />a F. In -Tank Gauging / SIR Equipment: <br />e Ulat ,", 0 of Testing/Servicing: )0 /-3/ /D`! <br />❑ Check 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 />U Yes <br />I ❑ <br />No* <br />I Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />❑ Yes <br />❑ <br />No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />❑ Yes <br />❑ <br />No* <br />Was accuracy of system product level readings tested? <br />❑ Yes <br />' ❑ <br />No* <br />Was accuracy of system water level readings tested? <br />❑ Yes <br />❑ <br />'No* <br />Were all probes reinstalled properly? <br />❑ Yes ❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />___ ____ �__.. ...., . ,., .., ,., ,,., ,� ,.vs a■.0 v.u�c,Is Mac ucuceeucees were ur wm Ue currecteu. <br />G. Line Leak Detectors (LLD): ®, <br />'Check this box if LLDs are not installed. <br />COmDlete the Thllnwino checklist! <br />❑ Yes <br />❑ <br />No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />❑ <br />N/A <br />(Check all that apply) Simulated leak rate: ❑ 3 g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. <br />❑ Yes <br />❑ No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />❑ Yes <br />❑ No* <br />I Was the testing apparatus properly calibrated? <br />❑ Yes <br />❑ <br />No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ <br />N/A <br />❑ Yes <br />❑ <br />No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />❑ <br />N/A <br />D Yes <br />❑ <br />No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />❑ <br />N/A <br />or disconnected? <br />❑ Yes <br />❑ <br />No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br />❑ <br />N/A <br />malfunctions or fails a test? <br />❑ Yes <br />❑ <br />No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />❑ <br />N/A <br />❑ Yes <br />❑ <br />No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />..v- ..,.....I .,.,,.,,,t a.......... ■■uar all "mull t !Vac UCIIUMICICS were ur win De corrected. <br />H. Comments: <br />Pale 3 of 3 05/00 <br />