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SIR. Equ` ��t: VCheck kiis box if to ag; ng is used only li>r ir;ventor 1 ❑ Check this box if no tunicau Ting or SII; equipmc;nt is installed." g� b 5 This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: ❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? ❑ Yes ❑ No* Was accuracy of system product level readings tested? ❑ Yes ❑ No* Was accuracy of system water level readings tested? ❑ Yes ❑ No* Were all probes reinstalled properly? ❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deliciencies were or will be corrected. G. Line Leak (Detectors (LLD): ®/ Check this box if LLDs are not installed. Complete the following checklist: S'aC-7rl0W ❑ Yes ❑ No*L3For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? N/A I (Check all that apply) Simulated leak rate: ❑ 3 g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. ❑ Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? ❑ Yes ❑ No* Was the testing apparatus properly calibrated? ❑ Yes ❑ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ N/A ❑ Yes ❑No* L3 N/A For electronic LLDs, does the turbine automatically shut off if the LLD .detects a leak? ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled ❑ N/A or disconnected? ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off, if any portion of the monitoring system malfunctions ❑ N/A or fails a test? ❑ Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? ❑ N/A ❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencieswere or will be corrected. H. Comments: Page 3 of 3 03/01