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,Site Address: 41 � u f` T — �e of'festing/Servicing: <br /> F. in-Tank.Gauging/ SIR Equipment: eck Tthis 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-lank gauging equipment is used to perform leak detection monitoring. <br /> Complete the following checklist: <br /> ❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br /> ❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ❑ Yes --d—No* Was accuracy of system product level readings tested? <br /> ❑ Yes ❑ No* Was accuracy of system water level readings tested? <br /> ❑ Yes ❑ No* Were all probes reinstalled properly? <br /> ❑ Yes 13No* 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): ❑ Check this box if LLDs are not installed. <br /> Com et e the following checklist: <br /> Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br /> ❑ N/A (Check all that apply) Simulated leak rate: .; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. <br /> FesNo* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> ❑ No* Was the testing apparatus properly calibrated? <br /> s ❑ No* For mechanical LLDs,does the LLD restrict product Flow if it detects a leak? <br /> ❑ N/A <br /> Yes ❑ Ngo* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br /> ZI Cd'N/A <br /> Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> fN/A or disconnected? <br /> ] Yes ❑ X6* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br /> Er N/A malfunctions or fails a test? <br /> Y , ❑ o* For electronic LLDs, have all accessible wiring connections been visually inspected? <br /> 0 N/A <br /> 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 /> 1. Comments: 7_,4i 40 io'5 ,go <br />