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4FECEIVEU SEP 2 6 2016 ``,,II�� t�In/I j� 6 � ALTH F. In -Tank Gauging / SIR Equipment: P Check this box if tank gaugin�NVIRQ4 'fUF4h�hCo y tonfrol. r Check this box if no tank gauging or SIRDEIRARUENT This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: + Yes r No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? • Yes r No* Were all tank gauging probes visually inspected for damage and residue buildup? + Yes r No* Was accuracy of system product level readings tested? • Yes r No* Was accuracy of system water level readings tested? • Yes No* ere all probes reinstalled properly? • Yes No* ere all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): r Check this box if LLDs are not installed. Complete the following checklist: Yes r No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? (Check all that t;; apply) Simulated leak rate: r 3 g.p.h.; r 0.1 g.p.h; 0.2 g.p.h. N/A Yes No* Were all LLDs confirmed operational and accurate within regulatory requirements? Yes r 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 r No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? N/A • Yes r No* For electronic LLDs that are programmed for positive shut down, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? N/A • Yes r No* For electronic LLDs that are programmed for positive shut down, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? N/A Yes r No* For electronic LLDs, have all accessible wiring connections been visually inspected? N/A Ir Yes No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. n. comments: No LD was tested. Page 3 of 3 12/07