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SiteAdress: W�� �c_ v?-r _ t'f -z' ' �" '� hof D# Testing/Servicing: I I� <br /> F. In-Tank Gauging / Slit F;yuitrtnent: ❑ Check this box if tank,gauging is used only for inventory control. <br /> U Check this box if no tank gauging or SIR equipment is installed. <br /> This section must be completed ifin-tank gauging equipment is used to perform leak detection monitoring. <br /> Complete the following checklist: <br /> ❑ Yes ❑ No* Has all input wiring been inspected I-or proper entry and termination, including testing for ground faults? <br /> ❑ Yes ❑ No* Were all tank gauging probes vistally inspected for damage and residue buildup? <br /> ❑ Yes ❑ No* Was accuracy of system product level readings tested? <br /> ❑ Yes ❑ No* Was accuracy of system water level readings tested? <br /> ❑ Yes ❑ No* Were all probes reinstalled properly? <br /> ❑ Yes I ❑ No* I Were all items on the equipment manufactur'er`s maintenance checklist completed? <br /> * In the Section H, below, describe how and waren these deficiencies were or will be corrected. <br /> G. Line Leak Detectors (LLD): ❑ Check this box if[.L[)s are not installed. <br /> Complete the following checklist: <br /> U-1-es ❑ No* For equipment start-up or annual eelnipment certification, was a leak simulated to verify LLD performance? <br /> ❑ N/A (Check a//that appl,i) Simulated leak rate: C1177p.h.; G U.1 g.p.h ; ❑ 0.2 g.p.h. <br /> Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> es ❑ No* I Was the testing apparatus properly calibrated? <br /> Yes ❑ No* For mechanical LLDs,does the I.1-D restrict product flow if it detects a leak? <br /> ❑ N/A <br /> ❑ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> a <br /> ❑.Yes 17 No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled, <br /> 1 i /A or disconnected? <br /> ❑ Yes ❑ No* For electronic LLDs, sloes the turbine automatically shut off if any portion of the monitoring system <br /> U N/A malfunctions or fails a test? <br /> ❑ Yes ❑ No* For electronic IA,t)s, have all accessible wiring connections been visually inspected? <br /> CI"'N/A <br /> Ef Yes ❑ No* Were all items on the equipment rnnmrfacturer's maintenance checklist completed? <br /> * In the Section H, below,describe how and when Ilrese deficiencies were or will be corrected. <br /> H. Comments: <br /> Page 3 of 3 05/00 <br />