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1 � � <br />TT °� n <br />F. In -Tank Gauging / SIR Equipment: n Check this box if tank gauging is used only for inventor�ntrc,2 0 201 <br />r7Check this box if no tank gauging or SIR equipment is installed. <br />L, <br />!�_ <br />This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. i <br />Complete the following checklist: <br />• Yes <br />C No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />f•' Yes <br />r No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />• Yes <br />C No* <br />Was accuracy of system product level readings tested? <br />G Yes <br />r No* <br />Was accuracy of system water level readings tested? <br />F Yes <br />r No* <br />Pere all probes reinstalled properly? <br />Yes <br />Ir No* <br />1were 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): ❑ Check this box if LLDs are not installed. <br />Complete the following checklist: <br />i Yes <br />!' No" <br />For equipment start-up or annual equipment certificationwasa leak simulated to verify LLD performance? (Check all that <br />r <br />apply) Simulated leak rate3 g.p.h.; ❑ 0.1 g.p.h; L 0.2 g.p.h. <br />N/A <br />C" Yes <br />No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />Yes <br />No* <br />Was the testing apparatus properly calibrated? <br />r Yes <br />f' No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />N/A <br />C Yes <br />�' No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />f� N/A <br />(� Yes <br />�' No* <br />For electronic LLDs that are programmed for positive shut down, does the turbine automatically shut off if any portion of the <br />C. N/A <br />monitoring system is disabled or disconnected? <br />f Yes <br />(_ No- <br />For electronic LLDs that are programmed for positive shut down, does the turbine automatically shut off if any portion of the <br />C <br />monitoring system malfunctions or fails a test? <br />N/A <br />f Yes <br />C No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />10 N/A <br />• Yes <br />No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />- in the Section ", below, describe now and when these deficiencies were or will be corrected. <br />H. <br />no <br />Page 3 of 3 12/07 <br />