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RECInVEDr Check this box if tank auging is used only for inventor <br /> F.In-Tank Gauging/SIR Equipment: 9 <br /> r Check this box if no tank gauging or SIR a ui t is installed. <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. <br /> q P� , 15 .2014 <br /> Eff v NMENTgL <br /> Complete the following checklist: HEALTH p <br /> f+' Yes r No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> r Yes �' No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> r Yes r No* Was accuracy of system product level readings tested? <br /> (70 Yes r No* Was accuracy of system water level readings tested? <br /> r Yes No* Were all probes reinstalled properly? <br /> 16- Yes No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> *In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> G.Line Leak Detectors(LLD): r Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> r* Yes (' No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance?(Check all that <br /> r N/A apply)Simulated leak rate:r 3 g.p.h.; r 0.1 g.p.h; r 0.2 g.p.h. <br /> C Yes C No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> C Yes (' No* Was the testing apparatus properly calibrated? <br /> r- Yes �' No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> C� N/A <br /> r Yes r No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> G N/A <br /> Yes r No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> 0 N/A <br /> r Yes (— No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> (: N/A <br /> r Yes (_ No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> G N/A <br /> Yes C No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> *In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> Page 3 of 3 12/07 <br />