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tQ (heck this box if tank gauging is used only for inventory control. <br />F. In -Tank Gauging/ SIR Eq Pluuerl. 0 Check this box if no tank gauging or SIR CquiPment is installed. <br />This section must be completed if in -tank gauging equipmentis used to perform leak detection monitoring. <br />Co Tete the fellowi clteckTist and - testing for ground faults? <br />ClAW <br />Yes Q No's Has all input's UM& t� irss- �.V r erg <br />Q yes Ct No* Were aiI tank gangingTuOb� vrsrtally i�ted <br />for residue buoup? <br />O Yes ❑ No* Was a=Wley of system product level readings <br />E3 Yes 0 Noy` Was accuracy of system water level tested <br />❑ Yes 0 No* Were all probes reinstalled y - <br />Q Yes ®No* Vere all items on nipmeut rnanufacnirer's maintenance checkIM completed? <br />earreded- <br />* In the Section below, <br />hour and when these dein ' were or will be <br />G. Line etectoPs GILD) -'Q Check this box if LLDs are not instailed- <br />lets the follow c3teckiisE: i <br />es Q No* For exlttigtnent start-uF or annual equipment certification, was a leak simulated to verify LLD perfortnanee. <br />Q No* (Check ail that applj`i Simulated lest ram• p h; 014.1 g P h: Q U 2 g p h. <br />jYesre,� <br />* Were all LLDS c;onftrmed ®Ferational and aceta 4c withir► regulatory requMments <br />* Was the testing apparatus progeny r�brated? <br />* For meeba wcal LLDs, does the LLD restrict product flava if it detects a leak? <br />A a ? <br />o* Tor efexxnonicLLI�s. does tine tttritim autaaoatcayAshutoffifanyportion of the monitoring systean is disabled <br />oy` For electronic LLDs, does the torbineautomatieail' <br />tA or ciiscot>t�eox For elaetrouic LLDs, does the t urbme automatically abut of if any portuan of tie moniwrig system malfunctions <br />IA or faib a test? <br />b Yes LNNeFor electronic LLDs, ?naveallaccessibewiring . bi n visually inspoCrexl? completed? <br />Were all items on the equipmetttmanaFfacturW s main <br />In the section 11, Mow, deem -be how and when tie defieisnc were or will be corrected. <br />H. Comments: <br />Page 3 of 3 03102 <br />