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AUG-24-2005 12:33 Service Station Systems 408 938 8888 P.05 <br /> R In-Tank Gauging/SYR Equipment: /Check this box if tank gauging is used only for inventory control. <br /> © Check this box if no tttnk gguging or SIR equipment is installed.. <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. <br /> Co let e the fvllowiu checklist: <br /> M © Na* Has all input wiring been inspected for proper entry and termination,including testing for ground faults'? <br /> ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ❑ No* Was accuracy of system product levi:l readings tested?❑ No* Was accuracy of system water level readings tested? <br /> L3 No* Were all probes reinstalled properly? <br /> C <br /> -'es ❑ No* Were all items on the cquipment manufacturer's maintenance checklist completed? <br /> *in the Section H,below,describe how And when these deficiencies were or will be correized. <br /> G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. <br /> Com to the followin checklist: <br /> es ❑ No* For equipment start-up or annual equipment c ification, was a leak s elated to verify LLD performance'? <br /> tON/A (Check all that apply) Simulated leak rate: 3 g.p.h.; CIO.' g.p.h; ❑ .2 g.p.h- <br /> 0 No* Were all LLDs confirmed operational and accurate within regulatory req rernents? <br /> 0 No` Was the testing apparatus properly calibrated? <br /> i <br /> No* or mechanical LLT)s,docs the LLD resuict product flow if it detects a 1 A <br /> No* For electronic LLDs,does the turbine automatically shut off if the LLD d rets a leak? <br /> ❑ N/A <br /> Yes 13No* For electronic LLDs,docs the turbine automatically shut off if any porti� of the monitoring system is disabled <br /> U NIA or disconnected? <br /> es ❑ No* For electronic LLI)s, does the turbine automatically shut off if portion of the monitoring system <br /> ❑ N/A malfunctions or fails a test? <br /> e O lv'n* For electronic LLDs,have all accessible wiring connections been visaall inspected'? <br /> ❑ N/A <br /> Yes Cl No* 'Were all items on the cquipment manufacturer's maintenance checklist c pleted? <br /> *In the Section H,below,describe how and when these deficiencies were or will be corre ted. <br /> . <br /> R. Comments. <br /> Page 3 of 3 •�,^ l 03101 <br /> I <br />