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F. 111=Tank CaukinK /SIR hquipntent: U Check this box if tank gauging is used only for inventory control. <br />U Check Ibis hox if uo lank gauging or SIR equipment isinWlled. <br />This section must be completed if in -tank gauging equipment is used to perform leak detection monitoRilg. <br />Complete the following checklist: <br />O Yes 10 No' Has all input wiring been inspected for proper entry and termination, including testing for groundfsults? <br />O Yes ❑ No' Were all lank gauging prohes visually inspected for dnnmge and residue buildup? - <br />❑ Yea ❑ No* Was accuracy of system product level readings restart? " <br />-- <br />O Yes ❑ No* Was accuracy of system water level readings tested'? <br />ILI Yes I ❑ No' Were all probes reinstalled properly? <br />u r es I u tvo- I were all nems on me equrpmrnt 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 Detectol's (1.1.U): U ('hrrk this box it"L1.11s are not ul fallyd. <br />Complete the following checklist: <br />es ❑ No' For equipment start-up or annual equipment certification, was a leak simulated to verify LLD perfosmsaee? <br />Ll NIA (Check all that apply) Sinnrlated leak rate: �p.h.; LJ 0.1 g.p.h ; 130.2 g.p.h. <br />Yes 13No" Were all LLDs conffmned operational and accurate within regulatory requirements? <br />Yes ❑ No' Was the testing apparatus properly calibrated? <br />U Yes <br />LJ <br />No' <br />For mechanical LLDs, does the 1.1.1) restrict product flow if it detects a leak? - <br />Lr_N/A <br />Rryes <br />❑ <br />No* <br />For electronic LLDs, does the hobine automatically shut off if the LLD detects a leak? <br />Cl <br />N/A <br />Yes <br />❑ <br />No' <br />For electronic LLDs, does nue turbine automatically shut off if any, portion of the monitoring system is disabled <br />❑ <br />N/A <br />or disconnected? <br />Yes <br />1❑ <br />No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring, syatpsp <br />❑ <br />N/A <br />malfunctions or fails a test? <br />Yes <br />❑ <br />No• <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />❑ <br />N/A <br />In Yes 113 <br />No' <br />Were all items on the equipment nr:nml ncturcr's maiulenance 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 0371 <br />