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1�1 <br />I <br />4 U 61 61 1 - <br />4 <br />-]I- <br />This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. <br />Complete the following checklist: <br />rr �M <br />and termination,mc luding testing for ground faults? <br />VSKM- <br />M Hull VV#' <br />Notes: 1. Required for equipment start-up certification and annual certification. <br />2. Unless mandated by local agency, certification required only for electronic LLD start uI6. <br />41- <br />&VA I =T, MUM, <br />* In the Section H, below, describe how and when these deficiencies were or will he co d. <br />MIUM <br />MM-74MI R , I <br />rLum <br />For equipment start up or annual equipment qp*ification., was a leak simulated to verify LLD Performance? <br />(Check all that apply) Simulated leak rate: e3 g.p.h. 1; 0 0. 1 g.p.h.'; 0 0.2 g.p.h.' <br />Notes: 1. Required for equipment start-up certification and annual certification. <br />2. Unless mandated by local agency, certification required only for electronic LLD start uI6. <br />the testing apparatus property calibrated? <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak <br />For electronic LLDs, does the Unix= automatically shut off if the LLD detects a leakI <br />For electronic LLDs, does the turbine automatically shut off if am portion of the momtonng system', <br />VEAM <br />malfiinctions or fails a test? <br />FHIM <br />I <br />a1a <br />PIK <br />or electronic LLDs, have all accessible wiring connections been visually inspected? <br />JWM�I <br />-Were-all-items on the equipment mantifitcturer's Is, intenancechecklist completed? <br />* In the Section % below, describe how and when these deficiencies were or will be corrected. <br />Page 3 of 3 03/01 <br />