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RECEIVE® <br /> APR 01 2014 <br /> F.In-rank Gauging/SIR Equipment: r Check this box If tank gauging is used only for inventory control. <br /> r Check this box if no tank gauging or SIV"ONMENTAL <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. CHEALTH DEPARTMENT <br /> Complete the following checklist: <br /> • Yes r No* las all Input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> • Yes r No* Nere all tank gauging probes visually Inspected for damage and residue buildup? <br /> • Yes r No* Nas accuracy of system product level readings tested? <br /> IT Yes No* Nas accuracy of system water level readings tested? <br /> • Yes r No* Nere all probes reinstalled properly? <br /> • Yes No* Nere 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): r Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> • Yes f No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance?(Check all that <br /> N/A pply)Simulated leak rate:r 3 g.p.h.; r 0.1 g.p.h; r 0.2 g.p.h. <br /> • Yes No* Nere all LLDs confirmed operational and accurate within regulatory requirements? <br /> IT. Yes No* Nas the testing apparatus properly calibrated? <br /> G. Yes r No* For mechanical LLDs,does the LLD restrict product flow if It detects a leak? <br /> r N/A <br /> Yes No* or electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> • N/A <br /> • Yes No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> IT N/A <br /> • Yg No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> • N/A <br /> • Yes r No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> • N/A <br /> • Yes No* ere 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: <br /> Page 3 of 3 12/07 <br />