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002196 <br />F. In -Tank Ganging / SIR Equipment: W.Check this box if tank ganging is used only for inventory eontmL <br />t3- 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 perforin leak detection monitoring. <br />!'mm�lafw iha rnllnwina rhartrtP.cte _ _.— <br />U,Yts <br />❑ No* <br />Has all input wiring been inspected for ptgper entry and termination, including testing for ground faults? <br />5 -Yes <br />❑ Noy <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />a -Yes <br />❑ No* <br />Was aceursey of system product level readings tested? <br />M—Yes <br />❑ No* <br />Was accuracy of system water level readings tested? <br />es <br />0 No* <br />Were all probes reinstalled properly? <br />es <br />❑ No* <br />Were all items on the equipment mamrfactarer`s maintenance checklist completed? <br />* In the Section H, below, describe now ana wnea mese aencteacres were or wen uo eorreewu. <br />G. Line Leak Detectors (LLD): ❑ Check this box if LLDs aro not installed. <br />t,em i <br />tumne <br />ug cacmmw <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />iLF-'Yes <br />❑ No* <br />❑ NIA <br />(Check all -OW apply) Simulated leak rate: WT9.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g p h. <br />R -Yes <br />❑ No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />51 -Yes <br />❑ No* <br />Was the testing apparatus properly calibrated? <br />lid-OYeg <br />❑ No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />'s <br />JK NIA <br />g -'Yes <br />❑ No* <br />1 For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />❑ NIA <br />C�Y7tes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shot off if any portion of the monitoring system is disabled <br />❑ N/A <br />or disconnected? <br />5 -Yes <br />❑ No* <br />Bot 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 I-LDs, have all accessible wiring connections been visually inspected? <br />❑ NIA <br />es <br />❑ No- <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />w in t:he,ection ti, below, aescrioe now ana ween mese ue-ciencim v— ur -- uc --.— <br />H. Comments: <br />Page 3 of 3 DMI <br />