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_ <br />HWON WdWN '6l '(np awil p;A1;3 <br />F. <br />In -Tank b"44 / Selz Equipment ® Chwk this box !tank gavaing is used oNy for lnvgltoay mntrd <br />❑ Chark this bmt if rto tank gauging or 8112 e"(prnew Is fnatgltod. <br />Thla MUM must be mmpte0ml flMink 9a49149 e"mmnt is used to perform leak dedecdon manhodna. <br />conrWato M®fo8otxtng <br />eheeldtatr , <br />IN Yes <br />O Not <br />Has A stput WWM been hsperWd ter proper entry and tarttnne0an, Including teadnS far V-md f 9"t ? <br />Yes <br />No° <br />Vfte a9 tank gouging pmbrs vloufib isiepeded for donMe and residue WNW? <br />� Yea <br />❑ No' <br />Was mvxracW of system pmduot level readings WWI <br />Yes <br />❑ No' <br />Ma a=rdcy of ayatem Water lcvd readho taated? <br />IF Yiw <br />0 Na* <br />Vftvall probesrelnsMWproperty? <br />® Yea <br />3 No' <br />Vftm adl items on tho equipment menrdaclurers matmenancm nheotdiet Ccrrrrpleted? <br />' In iatffiotr K Agarllra how an wen thee, AeflWM ,revs or Will be CO. . <br />Lina Leak nVtwWM 01012 012 <br />® Check pale box if LLDS as not krateled, <br />COm etch dtirt <br />eheetdlatr <br />Yee <br />❑ No' <br />For eg4lpmr emR or annual sauiprnent aerftl=on, wase leak oinw ided t0 vettly LLb paWrrnanco? (C t l,* ed pact apply) <br />❑ N/A <br />Simulated leek vale. RD S ".h.: ❑ 9.1 S p h : ❑ 0,2 q^h. <br />10 Yes <br />0 Tie <br />Were aM LLDs otm8rmcd opeaado" and awoumte within mgWaataay rega iimertia? <br />Yes <br />No" <br />W. the t.WW appy MN. propady calibrated? <br />Yee <br />No' <br />For mochardad LI.Dai dans the LLD restrict product flow 0 It detects a 1aak4 <br />WA <br />❑ NW <br />For elecWnicLLDa, dap, tttehet ine auwmatlnetly ohutoif if the LQ3 det-W n lask7 <br />BI N/A <br />® Yes <br />❑ NV <br />For eiecore do LLD% d9 a the turbine au0p nsdaally shut off Nally portion of the manimrirm "an i. dlsaamed ordlaoonnected? <br />® N/A <br />Yoe <br />® Na' <br />For elaauonic LLDs, dose the turn" autematically abut off rt any par"" of the monitoring Mftm MWNMdfarta or fang a tuft? <br />® N/A <br />Q Yes No* 1w electronic LL.Da, have as aa�ealt>b wlatng oonneeOvos been visually InepoCtad? <br />NIA <br />® Yes, ❑ Na' WareailItemsonthe .9i4mentmenufaewerarrraintwwwAWerddtvteampleted? <br />in Sete.. N, kpla" daiortbe caw,and wA.n ,aa d,Ockuteft- Orwill be eorv..s.d. <br />H. C <br />