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0 <br /> Site Address: Date of Testing/Servicing: <br /> F. In-Tank Gauging /SIR Equipment: ❑ 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 /> C96plete the IMWI- In c <br /> es ❑ No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> es ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> es ❑ No* Was accuracy of system product level readings tested? <br /> es ❑ No* Was accuracy of water level readings tested? <br /> es ❑ No* Were all probes reinstalled properly? <br /> Yes ❑ 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 /> G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. <br /> C94aplete the fbfl ng checklist: <br /> Yes ❑ No* For equipment start-up or annual equipment cation, was a leak simulated to verify LLD performance? <br /> ❑ N/A (Check all that apply) Simulated leak rate: 3 g.p.h.'; ❑0.1 g.p.h.2; ❑0.2 g.p.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 /> Y 11 No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> es ❑ No* Was the testing apparatus property calibrated? <br /> Yes ❑ No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> ❑ NIA <br /> ❑ Yes ❑ * For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> MrN'A <br /> ❑ Yes ❑ * 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 ® * For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br /> N/A malfinbctions or fails a test? <br /> E❑ Yes ❑ o* For electronic LLDs, have all accessible wiring connections been visually inspected? <br /> N/A <br /> Yes ❑ 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 co <br /> H. Comments: <br /> Page Yof 3 03/01 <br />