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Site of'l' b r <br /> Fe In-Tank Gauging/SIR Equipment Q Check this box if tank gmging is used only for inventory amnxiL <br /> ® Check this box if no tank gaugmg or SIR equipmeiAis in <br /> This secuon mam be cornpleted if mi-tank gaugmg equipment is used to perfbrm leak detechon trtowtorrt�g. <br /> cam the--- <br /> MrYes D No* Has all mput wmng been mqx=ed for FUW Wft3r and immunation,including temng fas ground faufts? <br /> Z 'Yes 0 No* Were all tank gmWj3g probes visuaft ins and residue WdduD7 <br /> Yes 0 No* W2S accuracy of system product level readings tested? <br /> Yes 0 Nei' Was 2=13112CY of SySteM water level madmgs tested? <br /> [E'Yes n No* dere all pubes rel ? <br /> fir-Yes.. 0 N& Were alk'items on the equipment manu&c=Ws mamtenance checklist completed`7 <br /> In the Section H,below,describe how and when these deficiam6w were or will be corrected- <br /> G. Lie (LLD): II Check this box if LLDs a-e na' lea. <br /> Compleft The faffewing checklist- <br /> 93-Yes 0 No* For equipment staxt-up or annual equipment c=tffzaUon- was a leak sunnhaed to verify LLD ? <br /> II N/A (C erk a/I that apptv simaiated.ic*rate: tl-n g p_b.'; 0 0-I g.p_b_'- 0 02 g p.b-2 <br /> I_ Requised for equipment _ CMbfiC2ftM and 2MM3W ceitffication- <br /> 2- Unless mandated by loc2l agencycartiffcatmix regairm only jbr ehxmxnc LLD start-op. <br /> es 0 No* Were aII LLDs con&med opmadonal and mcuratewfilimgy ? <br /> Z?Yes 0 No* Was the testing Mm=w p ? <br /> 0 Yes Mr No* For if it detects a IeW <br /> 0 N/A <br /> 0 Yes fl * For ehx=w ILDs,does the tintme automatically shat ofd if the LLD aCOXtS a ? <br /> M"MA <br /> 0 Yes 0 No* For efecamc l'ID&does the off if any pardon of the mamtorMg sysiem.is dbialiled <br /> FEMA or disconnected9 <br /> 0 Yes n Na* For elechumc LLQ does the ttubme aotomaEitallv shat off if any PDMW of the nomtorring <br /> Eg/ i/A malfiractims or fails a test? <br /> Q Yes 0 No* Forek=ionic s.Dave all acces&le-wising-comi=fions been,visualky ? <br /> A <br /> Yes Q No* Were all items on the equipmem man 's mamte nanrr cbeckha completed? <br /> In the Section Iff,below,describe haw and wimm these deficiencies were or will be <br /> Page 3 of 3 031M <br />