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Em vs i—Mi-I <br /> OCT 2 6 2015 <br /> NTAL <br /> 1`asVw <br /> F.In-Tank Gauging/SIR Equipment: r Check this box if tank gauging is used only for Ir)CpapTAACkIT <br /> Check this box if no tank gauging or SIR equipment i led' <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. <br /> Complete the following checklist: <br /> • Yes No* as all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> • yes No* ere all tank gauging probes visualty inspected for damage and residue buildup? <br /> • yes No* as accuracy of system product level readings tested? <br /> • yes No* as acwracy of system water level readings tested? <br /> • Yes No* ere all probes reinstalled properly? <br /> • Yes No* ere all items on the equipment manufacturers 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 /> • Yes - No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance?(Check all that <br /> N/A PPly)Simulated leak rater 3 g.p.h.; ❑0.1 g.p.h; it 0.2 g.p.h. <br /> • Yes No* Afere all LLDs confirmed operational and accurate within regulatory requirements? <br /> IT Yes No* NaS the testing apparatus property calibrated? <br /> IT Yes No* For mechanical LLDs,does the LLD restrict product flow I it detects a leak? <br /> N/A <br /> • Yes No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> • N/A <br /> • Yes No* r electronic LLDs that are programmed for positive shut down,does the turbine automatically shut off if any portion of the <br /> r N/A monitoring system is disabled or disconnected? <br /> • N/A <br /> • <br /> Yes r No* For electronic LLDs that are programmed for positive shut down,does the turbine automatlolly shut off if any portion of the <br /> • N/A monitoring system malfunctions or fails a test? <br /> • Yes r No* For electronic LLDs,have all accessible wiring connections been visually Inspected? <br /> • N/A <br /> • Yes r No* Were all items on the equipment manufacturers 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 12107 <br />