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6 <br />' F. In -Taal® Gauging / SIR Eqwent: <br />Check this box if tank ging 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 />ComailPte tho fnllnwina APPLIkt- <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 />F in the Section H, below, describe how and when these deficiencies were or will be corrected. <br />G. Line Leak Detectors (LLD): <br />Cmmnlete the fallowinfr checklist <br />❑ Check this box if LLDs are not installed. <br />12( <br />❑ No* <br />For equipment start-up or annual equipment ertification, was a leak simulated to verify LLD performance? <br />❑ N/A <br />(Check all that apply) Simulated leak rate: �3 g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. <br />No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />P <br />❑ No* <br />Was the testing apparatus properly calibrated? <br />❑ No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ N/A <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />/A <br />❑ Yes <br />0 No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />N/A <br />or disconnected? <br />E3Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br />N/A <br />malfunctions or fails a test? <br />❑ Yes <br />4 No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />ja N/A <br />Yes <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />-" iu u,e aecuun n, ueluw, aescr[ue now ana when tnese aeticiencies were or will be corrected. <br />H. Comments: t,t <br />Par,�-3 of 3 03/01 <br />