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r lr i n r uuum rHVt 014 <br /> F. In-Tank Gauging I SIR Equipment: O Check this box if tank gauging is used only for inventory control, <br /> a-Check this box if no tank gauging or SIR equipment is installed. <br /> This section must be completed if in-tank gaugint,equipment is used to perform leak detection monitoring. <br /> Com Tete the follo,% in checklist: <br /> Qt'y 0 No* Has all input wiring been inspected for proper entry and terrnination, including testing for ground faults? <br /> 0 Yes 0 No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> 0 Yes 0 No* Was accuracy of system product level readings tested? <br /> 0 Yes O No* Was accuracy of system water level readings tested? <br /> ❑ Yes 0 No* Were all probes reinstalled properly? <br /> ❑ Yes ❑ No* Were all items on the equipment imanufacturer'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): O Check this box if LLDs are not installed, <br /> Com Tete the fol-lo -ing checklist: <br /> O Yes Cl No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br /> O N/A (Check all dint apply) Simulated leak rate: 0 3 g.p.h.; 0 0.1 g.p.h; Q 0.2 g.p.h. <br /> O Yes 0 No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> ❑ Yes ❑ No* Was the testing apparatus properly calibrated? <br /> ❑ Ycs ❑ No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> O N/A <br /> O Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> 0 N/A <br /> Cl Yes ❑ No* For electronic LLDs, does the turbine automatically sheet off if any portion of the monitoring system is disabled <br /> ❑ N/A or disconntcted? <br /> ❑ Yes ❑ NO For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions <br /> C3 N/A oc fails a test' <br /> O Yes O No* For electronic LLDs, have all accessible wiring connections been visually inspected? <br /> ❑ N/A <br /> ❑ Yes M 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 03/01 <br />