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Site Address: pf�e '1Y j 6, Cy� /I D j yy , �p `��f uf'festing/Servicing: E. In-Tank Gauging/SIR Equipment: Q eheck this box if tank gauging is used only for inventory control. a ❑ Check this box if no tank gauging bog 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: ❑ Yes 1 ❑ No* I Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ❑ Yes ❑ No* Were all tank gauging probes visually inspected for damagjand residue buildup? LIYes ElNo* Was accuracy of system product level readings tested? L3Yes E3 No Was accuracy of system water level readings tested? C3Yes ❑ No* Were all probes reinstalled properly? ElYes ❑ No* Were 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): ❑ Check this box if LLDs are not installed. Complete the following checklist: IT—Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? ❑ N/A (Check all Mal apply) Simulated leak rate: ❑9 p`fi:; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. Ef Yes . I ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? Y s ❑ No* Was the testing apparatus properly calibrated? El'Yes ❑ No* For mechanical LLDs, does the LLD restrict product Flow if it detects a leak? ❑ N/A Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑'N/A Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled pr-14/A or disconnected? 7 Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system ErN/A malfunctions or fails a test? 3 Yes ❑ o* For electronic LLDs, have all accessible wiring connections been visually inspected? ❑ N/A Yes ❑ No* Were 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. 1. Comments: