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F. In -Tank Gauging / SIR Equipment: <br />is <br />❑ 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 />Corablete the fnllnwino rheekliste <br />es <br />❑ <br />Ne* <br />Has aL input icing been inspected for proper entry and termination, including testing for ground faults? <br />ff/Yes <br />❑ <br />No* <br />Were all tank gauging probesEM <br />cted for damage and resMbuildes <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />LlrYes <br />No* <br />Was accuracy of system prodngs tested?es <br />❑ Yes <br />❑ <br />No* <br />Was accuracy of system wates tested?s <br />❑ No* <br />❑ <br />No* <br />Were all probes reinstalled pr -Yes <br />❑ <br />*. <br />No* <br />Were all items on the equipmres s maintenance check <br />.,....� „�........... ..�,�„, ,lrxrluc huw anu when mese aenciencies were or will be corrected. <br />G. Line Leak Detectors (LLD): <br />Cmmnlete the fnllnwino rherklict- <br />❑ Check this box if LLDs are not installed. <br />Yes <br />❑ No* <br />For equipment start-up or annual equipment ce�tcation, was a leak simulated to verify LLD performance? <br />❑ N/A <br />(Check all that apply) Simulated leak rate: L93 g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. <br />❑ No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />LlrYes <br />❑ No* <br />Was the testing apparatus properly calibrated? <br />❑ Yes <br />❑ ale* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />es <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />❑ N/A <br />Iff Yes <br />❑ No* <br />For elect mic LLDs, does the turbine automatically -shut if -any of dte monitoring ­todisabled <br />❑ N/A <br />or disconnected? <br />M -fes❑ <br />No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br />❑ N/A <br />malfunctions <br />or fails a test? <br />Yes <br />❑ No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />❑ N/A <br />IT Yes <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />.,, 111U occuun n, heww, uescnoe now ana wnen tnese dericienetes were or will be corrected. <br />H. Comments: <br />Page 3 of 3 03101 <br />