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P. Ian -Tank Gauging / SIR Equipment: <br />id Check this box if tank gauging is used only for inventory control. <br />❑ Check this box if no tank gauging or SIR equipment is installed. <br />This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. <br />Cmmnlete the following eherkliste - <br />❑ Yes <br />❑ <br />No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />❑ Yes <br />❑ <br />No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />❑ Yes <br />❑ <br />No* <br />Was accuracy of system product level readings tested? <br />❑ Yes <br />❑ <br />No* <br />Was accuracy of system water level readings tested? <br />❑ Yes <br />❑ <br />No* <br />Were all probes reinstalled properly? <br />❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br />* T.. sl... CenHn..II 6d..... A-..... _:L.. L _� .� .�___ �..• .._ _ _ <br />--- ------------ --o ---- ••, .--�-• •••.• ..........v n..cu .u..uc um�ucum . W cf e us W UI Ue correcteU. <br />G. Line Leak Detectors (LLD): <br />. <br />Cmmnlete the following checklist <br />❑ Check this box if LLDs are not installed. <br />Yes <br />❑ No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />❑ N/A <br />(Check all that apply) Simulated leak rate: Of 3 g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. <br />® 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 />Yes <br />❑ No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ N/A <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />® N/A <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />IN N/A <br />or disconnected? <br />LiNo* <br />For electronic LLDs, does the turbine automatically shut off. if any portion of the monitoring system malfunctions <br />® N/A <br />or fails a test? <br />E <br />❑ No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />93 N/A <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />-.• •1, nc-.0 W, .,—" 1 V nuW anu Woen mese deficiencies were or will be corrected. <br />H. Comments: <br />Page 3 of 3 03ro1 <br />