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RECENED <br /> F. In-Tank Gauging/SiR Equiprrent: Check this box if tank gauging is used only for inv�Pfory c ntr I.,7 <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. ENVIRONMENTAL HEALTH <br /> Complete the following checklist: DEPARTMENT <br /> 1 Yes L No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> Yes No` Were ail tank gauging probes visually inspected for damage and residue buildup? <br /> ❑ Yes 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 /> F1 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 /> G. Ure Leak Dete%t:;isa_LD): <br /> ( ►• 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 <br /> ❑ N/A that apply) Simulated leak rate: ®3 g.p.h.; 0.1 g.p.h; r 0.2 g.p.h. <br /> ® Yes D No* Were all LLDs confirmed operational and accurate within regulatory requirement? <br /> ® Yes _ No* Was the testing apparatus properly calibrated? <br /> ® Yes No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> ❑ N/A <br /> ❑ Yes C No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ® N/A <br /> ❑ Yesj No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or <br /> ® N/A disconnected? <br /> Yes No. For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or <br /> ® N/A fails a test? <br /> Yes C No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> ® 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 /> :i. rviT:r�e3it3: <br /> monstoring System Ca;u`rcation - <br /> r�age s of a 12J07 <br /> 3 2/21/07 <br />