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s Site Address: ter ` VR __ of Testing/Servicing: <br />F. In -Tank Gauging/ SIR Equipment: k 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 />Complete the following checklist: <br />❑ Yes <br />I ❑ <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 <br />❑No* <br />❑ Yes <br />Were all probes reinstalled properly? <br />❑ Yes j <br />❑ <br />No* I <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />In Int; auction n, oelow, uescrloe now anu wnen [nese aciicieneies were or will be corrected. <br />G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. <br />Comalete the following checklist: <br />0-1'e's-- <br />❑ No* <br />❑ N/A <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />(Check all that apply) Simulated leak rate: g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. <br />es <br />❑ No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />e _ <br />-es <br />❑ No* <br />Was the testing apparatus properly calibrated? <br />930'Y <br />❑ No* <br />❑ N/A <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ Yes <br />❑ No* <br />A <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />❑ Yes <br />❑No* <br />N/A <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />or disconnected? <br />❑ Yes <br />❑ No* <br />q I <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br />malfunctions or fails a test? <br />❑ Yes <br />❑ N * <br />N/A <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />es <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />-" LII LIEU auction n, Uelow, uescrioe now anu wnen tnese aenciencles were or will be corrected. <br />1i-� 1 F:I4.YI <br />