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0 <br />F. In -Tank Gauging / SIR Equipment: @,Check this box if tank gauging is used only for inventory control. <br />❑-6eck 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 />b�n...,.lebn Ml.n Pnlln.ni.... nMnnirlia b. <br />U1--Y'es <br />❑ No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />[3—Yes <br />❑ No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />El—Yes <br />❑ No* <br />Was accuracy of system product level readings tested? <br />O--Y`es <br />❑ No* <br />Was accuracy of system water level readings tested? <br />EI -Yes <br />❑ No* <br />Were all probes reinstalled properly? <br />B—Ires <br />❑ No* <br />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 />/'n.....Tnbn 64.n Fniin...i..n n0. nnlrl:�b. <br />WYes <br />❑ No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />❑ N/A <br />(Check all that apply) Simulated leak rate: 0-3"g.p.h.; ❑ 0.1 g.p.h ; El 0.2 g.p.h. <br />©—Yes <br />El No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />W—Yes <br />13 No* <br />Was the testing apparatus properly calibrated? <br />® Yes <br />C3 No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ N/A <br />0—Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />❑ NIA <br />2 --Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />❑ N/A <br />or disconnected? <br />8—Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions <br />❑ N/A <br />or fails a test? <br />Yes <br />❑ No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />❑ N/A <br />�s <br />❑ No* <br />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. Continents. t' r / t ' }i' ,' r ` f ," <br />Page 3 of 3 <br />03/01 <br />