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AR r: 9!.t;11:71i"3r :Sf l: Ch'rA 111is boy, U (:•L'7+n. i iupirz• in u.-ml.i i'l'sly t')!' y (:i:l <br />l._f Check 01i:•; l -ox ti nu t%Idll: 01• SUZ C"jUiPINI M i$ Il!L't lilL�i. <br />,i i11S section mutit be completed if hi-OnIC gaiiging equipnlen't is vied to perforn) lcak duicetion monitoring <br />C'olltplelc the following checklist: <br />U Yes ❑ No* Has all input wiring bLLn im;pected for propel, entry and termination, including testing for ground .faults'? <br />❑ Yes U No* Were all tank gauging probes visnaliy inspected for daimigo ;Ind residue buildup? <br />U Yes ❑ NO Was accuracy oI'system product level readings tested? <br />D Yes D No* Was accuracy of system water level readings tested? <br />U Yes U No* Were all probes reinstallod Properly? <br />U Yes U No* Were all items on the equipment manufacturer's maintenance checklis( Completed? <br />In the Stetion t-1, below, describe how and when the -ie deficiencies were or will he correeted. <br />G. Line Leak YDeteetom check this box if U,Ds are not installed. <br />('mmnlcic the following checklist: <br />U Yes <br />L] No* <br />For equipment sort -up or annual equipnlwot ccrtilicution, was a leak simulated to verify LLD perfilrmancc? <br />U NIA <br />(Check all that apply) Simulated leak rote: ❑ 3 g_p.h.; ❑ 0.1 g.p-ll ; O 0.2 g.p.h. <br />❑ Yes <br />U No* <br />Were all LLVs confirmed operational and accurate within rcgulutory requirements? <br />❑ Yes <br />0 No* <br />Was the testing apparatus properly calibrated? <br />O Yes <br />❑ No* <br />For mechanical LLDs, dues the I11) restrict product flow if it detects a leak? <br />❑ N/A <br />--- — <br />❑ Yes <br />El No* <br />For electronic LLDs, docs the turbine automatically shut off if the LLD detects a leak? <br />❑ N/A <br />❑ Yes <br />❑ No* <br />For electronic LLD-, does the turbine autoulatically shut off it any portion of the monitoring system is disabled <br />❑ N/A <br />or disconnected? <br />U Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions <br />D N/A <br />or fails a test? _ <br />Cl Yes <br />❑ No* <br />For electronic Lens, have all accessible wiring connections been visually inspected? <br />❑ N/A <br />Cl Yes <br />U No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* in the Section H, below, aeserlbe now ane when mese uerlclencles were or wall uc corrceteu. <br />I.I. Comments- __-- _.......__.._.�._. <br />Page 3 of 3 o3mt <br />goo in ted TT:ZT 8001;/CTAT <br />