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E <br />Site Address: <br />F. In -Tank Gauging / SIR Equipment: <br />it <br />Date of Testing/Servicing: <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 />g&es <br />0 No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />92rYes <br />0 No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />2"Yes ' <br />0 No* <br />Was accuracy of system product level readings tested? <br />[Yes <br />0 No* <br />Was accuracy of system water level readings tested? <br />WYes <br />0 No* <br />Were all probes reinstalled properly? <br />WY'-4Ts <br />0 No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In the Section H, below, describe how and when thew deficiencies were or will be correcte(L <br />G. Line Leak Detectors (LLD): 0 Check this box if LLDs are not installed. <br />--OVW-- <br />ErYes <br />El No* <br />For equipment start-up ora equipment certification, was a leak Simulated to verify LLD performance? <br />0 NIA <br />(Check all that apply) Simulated leak rate: Ug,'3 g.p.h.1; 0 0.1 g.p.h.2; [10.2 gp.h.2 <br />Notes: 1. Required for equipment start-up certification and annual certification. <br />2. Unless mandated by local agency, certification required only for electronic LLD start-up. <br />EfYes <br />[I No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />WrYes <br />0 No* <br />Was the testing apparatus property calibrated? <br />0 yes <br />ff,-No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />0 N/A <br />0 Yes <br />[I No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />[j3 -NIA <br />0 Yes <br />0 No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />5YNIA <br />or disconnected? <br />0 Yes <br />0 No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br />W -N/A <br />malfunctions or fads a test? <br />0 Yes <br />0 No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />jFrN/A <br />LT�jes <br />0 No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In the Section % below, describe how and when these deficiencies were or will be corrected. <br />il. Comments: <br />Page 3 -of 3 03/01 <br />