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r <br />F. in -Tank Gauging/ SIR Equipment: <br />E <br />Check this box if tank gauging is used only for inventory control. <br />E3 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 fotiosriu checklist: <br />® Yes Q No* Has an input wiring bem.inspected forproper entry and termination, including testing for ground faults? <br />❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br />D Yes ❑ No" Was accuracy of system product level readings tested? <br />❑ Yes ❑ No* Was accuracy of system water level readings tested? <br />❑ Yes n Nn* I Were all probes reinstalled properly? <br />❑ Yes ❑ N -07T Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In the Section H, below, descin-be how and when these deficiencies were or will be corrected. <br />G. Line Leak Detectors Q,LD): ❑ Check this box if LLDs are not installed. <br />No* For equipment start-up or annual equipment c5rtification, was a leak simulated to verify <br />❑ N/A i (Check aR rhat aPPty) Simulated leak rat g.ph; E2 0.1 g p.h : ❑ 0.2 g.p.h. <br />r"1 N..* I w.,r alt t. 1 .tic rvmnftrmrd nneraoonal and accurata within rep-ulatary reauirements? <br />performance? <br />Yes <br />❑ No# <br />Was the testing apparatus properly calibrated? <br />❑ Yes <br />o • <br />For mechanical LLD% does the LLD restrict product flow if it detects a leak? <br />N/A <br />tJ Yes W No- rer mecuvruc L,t,us, over us; tuluma auwuticue._ury �'uut uat u uic 1.4_ucw�w. a .caa <br />O NIA <br />❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />Cl NIA or disconnected? <br />❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shutoff if any portion of the monitoring system malfimcdons <br />❑ NIA or fails a test? <br />❑ Yes ,.❑ No* For electronic LLDs. have all accessible wiring connections been visually inspected? <br />% ❑ NIA <br />er-yes ❑ No* I Were all itcros on the equipment manufacturer's maintenance checklist completed? <br />* Lu the Section H, below, descn'be how and when these deikieucies were or will be corrected. <br />H. Comments: <br />Page 3 of 3 03101 <br />