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9 <br />F. in- i anlc Gauging ! SiIZ Equipment: �C ter$ dtis box f tank gauging s toed only for Invemory 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 <br />monitoring. <br />❑ Yes ❑ No* Has all input wiring been inspected for prover entry and termination. including testing for ground faults? <br />❑ Yes C]No* Were all tank gauging probes visually inspected fordamage and residue buildup? <br />❑ Yes El No* Was accuracy of system product level readings tested? <br />❑ Yes I ❑ No* I Was accuracy lof system water level readings tested? <br />❑ Yes I ❑ No* I Were all hens on the equipment manufacturer's maintenance checklist completed? �I <br />* In the Section H, below, desen"be how and when these defiicienwere or will be corrected. <br />G- Line Leak Detectors (LLD): O Check this boz if LLDs are not mstaiieti <br />Cononiete the fodowine cheddist: <br />Yes <br />❑ No* <br />❑ N/A <br />For equipment start-up or annual equimwnE certification, was a leak simulated to verify LLD pen'ormance'? <br />(Check all the apply) Simulated leak rate: e3 ,.a -IL; ❑ 0.1 &p -h; Cl 0.2 g.p.h. <br />Yrs <br />❑ No* <br />Were all LLDs confirmed operetioaal and accurate within regulatory requarmens? <br />Yes <br />❑ No* <br />Was the testing apparatus properly calibrated? <br />Yes <br />❑ No* <br />❑ N/A <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ Yes <br />❑ No* <br />Z3 N/A <br />For electiouic T T r &, does the turbine automadcally shut off if the LLD detects a leak? <br />❑ Yes <br />❑Flo* <br />N/A <br />For eieclmffic II Ds, does the turbine automati=11y stmt off if any portion of the tmmmring system is disabled i <br />or disconnected? <br />❑ Yes <br />❑ fro* <br />LI NIA <br />For elecnonie LLDs, does the tumor automatically shot off if any pmdm of the mondoffig system malfunctions j <br />or fails a test? <br />❑ Yes <br />❑ o* <br />LT A <br />For electronic LLDs, have all accessible wining connection been visually i spected? <br />I <br />Yes <br />❑ No* <br />Were all items on the equipment manufacu rer s maintenance checklist completed? i <br />* In the Sedim % below, describe how and when these defioencies were or will be corrected. <br />M Com: <br />Page 3 of 3 <br />03101 <br />