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M IYA <br /> '-Taandlk Gauging/SIR Eq*ent- 0 Check this box if taOugirify is used only <br /> U Check this box if no tank gauging or SIR eq <br /> 49; <br /> uipmcn 1, <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. <br /> Coon late the following checklist: <br /> U Yes Q No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br /> LJ Yes Ll No* I Were all tank gauging probes visually inspected for damage and residue buildup? ground faults? <br /> Q Yes El No* Was-accuracy of system product level readings tested? <br /> L] Yes U No* Was accuracy of system water level readings tested? <br /> U Yes El No* Were all probes reinstalled properly? <br /> Q Yes U No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> * In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors (LLD): El Check this box if LLDs are not installed. <br /> _CDm&1ete the foliowin cheeldist: <br /> 10 Yes 99 No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br /> El N/A (Check all that apply) Simulated leak rate: 0 3 g.p.h.; Q 0.1 g.p.h; U 0.2 g.p.h. <br /> Q Yes 49 No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> a Yes Q No* Was the testing apparatus properly calibrated? <br /> 12 Yes L3 No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> U NIA <br /> U Yes U No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> Q N/A <br /> L3 Yes L3 No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> U N/A I or disconnected? <br /> Ll Yes U No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions <br /> U N/A or fails a test? <br /> Ll Yes U No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> Q N/A <br /> 110 Yes 10 No* I Were all items on the equipment manufacturer's maintenance checklist completed? <br /> *In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: -Or5 WO T -r e,-r <br /> WR 7 AUcW, So A10 W 1-r-5 <br /> 0 ,444E <br /> ro '11-tAfR <br /> AAO los -r -7-toqf 6-,— <br /> Page 3 of 3 03101 <br />