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1 0 <br />I+. In -Tank Ganging / SIR Equipment: <br />_o It AV/ <br />Check this box if tank gauging is used only for inventory control. <br />❑ Check this box if no tank gauging or Sl§ ffpuipnj1n O6jFtalled. <br />This section must be completed if in -tank gauging equipment is used to perform leakr419tllTi <br />s PER�� 1i'SERVIGES <br />Comn{ete the fnllnevina rhPrlclict- <br />❑ Yes <br />❑ No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />❑ Yes <br />❑ No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />❑ Yes <br />❑ No* <br />Was accuracy of system product level readings tested? <br />❑ Yes <br />❑ No* <br />Was accuracy of system water level readings tested? <br />❑ Yes <br />❑ No* <br />Were all probes reinstalled properly? <br />❑ Yes <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />.,. u— c.,u— a■, "U UVV, uua�l we 1-v amu mien I/1ese uerlciencie5 Were or Will De correcte[. <br />G. Line Leak Detectors (LLD): <br />CamntetP the fnllnwina rhPrklict- <br />❑ Check this box if LLDs are not installed. <br />Yes <br />❑ No* <br />❑ N/A <br />For equipment start-up or annual equipment erh kation, was a leak simulated to verify LLD performance? <br />(Check all that apply) Simulated leak rate j1O3 g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. <br />Yes <br />No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />kLl— <br />es <br />❑ No* <br />Was the testing apparatus properly calibrated? <br />Yes <br />❑ No* <br />LlN/A <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />Yes <br />❑ o* <br />N/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 />❑ o* <br />N/A <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 />❑ No* <br />N/A <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />Yes <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In the Section H. <br />below. describe how and when th P.cP rint'irianriae warn nr wiil he .... .......4 <br />H. Comments: ( � � LU ►�— i S 'r, CA C-0 U ( <br />e d <br />��Tage 3 of 3 <br />03/01 <br />