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r. <br /> Site Address: Date of Testing/Servicing: <br /> F. In-Tank Gauging /SLR Equipment: ❑ Check this 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-tank gauging equipment is used to perform leak detection monitoring. <br /> Complete the foil owinS checklist: <br /> ,Yes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br /> es ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ff/Yes ❑ No* Was accuracy of system product level readings tested? <br /> CY es ❑ No* Was any of system water level readings tested? <br /> Yes ❑ No* Were all probes reinstalled properly? <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 defiic�ienc/ley were or will be corrected, <br /> G� Line Leak Detectors (LLD): fig'Check this box if LLDs are not installed. <br /> Complete the folloprin checklist: <br /> ❑ Yes ❑ NO For equipment start-up or annual equipment certification, was a leak simulated to verify Ll.D performance <br /> ❑ N/A (Check all that apply) Simulated leak rate: ❑ 3 g.p.h,`-, ❑ 0.1 g.p.h.2, Cl 0.2 g.p.he2 <br /> Notes: 1, Required for equipment start-up certification and annual certification, <br /> 2. Unless mandated by local agency,certification required only for electronic LLD start-up. <br /> ❑ Yes 10 NO Were all LLDs confirmed operational and accurate within regulatory requirements? - <br /> ❑ Yes ❑ No* Was the testing apparatus properly calibrated? <br /> ❑ Yes ❑ No* For mechanical LLDs, does the LLD restrict product clow if it detects a teak? <br /> ❑ N/A <br /> ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br /> 4N/A <br /> ❑ Yes electronic LLDs, does the turbine automatically shut off if any portion of the monitorin <br /> disconnected? g system is disabled <br /> ❑ Yes electronic LLDs, does the turbine automatically shut off if any portion of the monitorin <br /> functions or fails a test? g system <br /> ❑ Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? _— <br /> ❑ N/A <br /> LYE <br /> ❑ 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 /> R. Comments: <br /> Page 3 of 303/01 <br />