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F.In-Tank Gauging/SIR Equipment: R Check this box if tank gauging iu5 sYCEI�of r Check this box if no tank gauging or SIR equipment is installed. �® This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. NOV 2 4 201,1 Complete the following checklist: ENVIRO^1 1't MPNIT Yes No* Has all input wiring been inspected for proper entry and termination, including testing for group 'V Yes No* Were all tank gauging probes visually inspected for damage and residue buildup? Yes r No* Was accuracy of system product level readings tested? Yes r No* Was accuracy of system water level readings tested? Yes No* ere all probes reinstalled properly? • Yes No* Were all items on the equipment manufacturer's maintenance checklist completed? *In the Section H, below,describe how and when these deficiencies were or will be corrected. G.Line Leak Detectors(LLD): Check this box if LLDs are not installed. Complete the following checklist: • Yes r No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance?(Check all that N/A apply)Simulated leak rate:P 3 g.p.h.; r 0.1 g.p.h; I 0.2 g.p.h. • Yes r No* Were all LLDs confirmed operational and accurate within regulatory requirements? • Yes r No* Was the testing apparatus properly calibrated? * Yes No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? N/A Yes r No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? • N/A Yes r No* For electronic LLDs that are programmed for positive shut down,does the turbine automatically shut off if any portion of the • N/A monitoring system is disabled or disconnected? Yes No* For electronic LLDs that are programmed for positive shut down,does the turbine automatically shut off if any portion of the • N/A monitoring system malfunctions or fails a test? Yesr No* For electronic LLDs,have all accessible wiring connections been visually inspected? ro N/A • Yesr No* ere all items on the equipment manufacturer's maintenance checklist completed? *In the Section H,below,describe how and when these deficiencies were or will be corrected. H. Comments: Page 3 of 3 12/07