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F. In -Tank Gauging / SIR Equipment: r" Check this box if tank gauging is used only for inventory control. r Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: Ya No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? Yes No* Nere all tank gauging probes visually inspected for damage and residue buildup? Yes No* Nas accuracy of system product level readings tested? Yes No* Nas accuracy of system water level readings tested? - Yes No* Nere all probes reinstalled properly? • Yes No* ere all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): r Check this box if LLDs are not installed. Complete the following cheddist: a ENVIRONMENTAL HEALTH DEPARTMENT • Yes No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? (Check all that apply) Simulated leak rate: r3 g.p.h.; r 0.1 g.p.h; 1 0.2 g.p.h. N/A • Yes No* Nere all LLDs confirmed operational and accurate within regulatory requirements? • Yes No* Nas the testing apparatus properly calibrated? • Yes No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? N/A Ya No* or electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? • N/A • Yes No* or electronic LLDs that are programmed for positive shut down, does the turbine automatically shut off if any portion of the onitoring system is disabled or disconnected? • N/A • Yes No* For electronic LLDs that are programmed for positive shut down, does the turbine automatically shut off if any portion of the onhoring system malfunctions or fails a test? • N/A • Yes No* For electronic LLDs, have all accessible wiring connections been visually inspected? • N/A • Yes No* ere all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. Page 3 of 3 12/07