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F. In—Tanlc Gauging / SIR Equ nt: Check this box if tanoging 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 />Complete the following ch, ^ ist: <br />❑ Yes <br />❑ <br />No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />❑ Yes <br />❑ <br />No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />❑ Yes <br />❑ <br />No* <br />Was accuracy of system product level readings tested? <br />❑ Yes <br />❑ <br />No* <br />Was accuracy of system water level readings tested? <br />❑ Yes ❑ No* Were all probes reinstalled properly? <br />❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In the goefinn M hAna r 11ne.,.n.i Ben 1..,.., --A ...1.,... 41....,_ .a_r__e___e__ <br />vvasl",G l UI■ GL1Gu. <br />G. Line Leaf Detectors (LLD): ❑ Check this box if LLDs are not installed. <br />Cmmnlote the fnllowina rhPoUict- <br />LS Yes <br />❑ No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />❑ NIA <br />(Check all that apply) Simulated leak rater 3 g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. <br />M Yes <br />❑ No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />Yes <br />❑ No* <br />Was the testing apparatus properly calibrated? <br />91- Yes <br />❑ No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ N/A <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />19 N/A <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />IN N/A <br />or disconnected? <br />❑ Yes <br />❑ No* <br />(� <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 />[k N/A <br />Yes <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* Tn thm C_ <br />+.-- u <br />1.01.,... .1........:1... 1. __-- <br />uciiGieL-m were or will pe correctea. <br />H. Comments: <br />Page 3 of 3 03101 <br />