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Sep 04 08 01 : 27p Afforda Test (2091 744-0116 p. 3 <br /> 0 checl. Ullis box if no lank ILZIMI`in!Zol-SiR eQL1iP111U:1t i� <br /> This section must be completed if in-tank- gauging equipment is used to perform leak detection monitoring. <br /> Complete the foU.3wina'cliecidist: <br /> CJ Yes 13 No* Has all input wiring been inspected for proper entry and termination, including testing for ground fILIItS? <br /> El Yes 11 No* Were all tank gauging probes Visually inspected for damage and residue buildup? <br /> 0 Yes ZI No* Was accuracy of system product level readings tested? <br /> El Yes 0 No* Was accuracy of system water level readings tested? <br /> 0 Yes 0 No* Were all probes reinstalled property? <br /> U Yes C3 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 /> G. Line Leak Detectors(LLD): El Check this box if LLDs are not installed. <br /> Co Tete the folio inchecklist: <br /> El No* For equipment start-up or annual equipmentWrtification, was a leak simulated to verify LLD performance? <br /> 0 N/A (Check a//that apply) Simulated leak=5;.42 3&P.h.; 0 0.1 g.p.h; LI 0.2 g.p.h. <br /> ler <br /> Yes 0 No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> AYes El No- Was the testing apparatus properly calibrated? <br /> Yes El No* ' For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> El N/A <br /> I CY Yes 0 No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ,e N/A <br /> ZI Yes 13,.,No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> N/A or disconnected? <br /> 13 Yes LI No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br /> �N/A malfunctions or fails a test? <br /> ❑ Yes 13 0* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> N/A 1 11 <br /> Yes C] 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 /> H. Comments: <br /> Page 3 of 3 03/)l <br />