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Site Ad Date of Testing/Servicing, <br /> F. In-Tank Gauging/SIR Equipment: ❑ Check this box if tank gauging is used only for inventory control. <br /> ❑ Check this box if no tank gauging or SIR equipment is insWled. <br /> This section must be completed if in-tank,gauging equipment is used to perforin leak detection monitoring. <br /> C e : <br /> es ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground ? <br /> ❑ No* Were all tank gauging probes visually mspected for damage and residue buildup? <br /> e/Yes ❑ No* Was accuracy of system product level readings tested? <br /> es ❑ No* Was accuracy of system water level readings tested? <br /> es ❑ No* Were all probes reinstalled properly? <br /> 19 Yes ❑ No* Were all item on the equipment mam is maintenance checklist completed? <br /> * In the Section H,below,describe how and when these deficiencies were or will be eo <br /> G. Line Leak Detectors(LLD): ❑ Check this box if LLDs are not installed. <br /> C the i'blt eh : <br /> FOYes <br /> ❑ No* For equipment. start-up or equipment cation, was a leak to verify LLD performance? <br /> ❑ N/A (Check all that apply) S' leak rate: 3 g.p.h.1; ❑4.1 g.p.h.Z; ❑0.2 g p.h 2 <br /> Notes: 1. R for equipment start-up certification and annual certification. <br /> 2. UN by i agency,certification required only for electronic LLD -up. <br /> ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> ❑ No* Was testing properly calibrated? <br /> d? <br /> ❑ No* For ince LL , LLD restrict flow if it d a leak? <br /> ❑ N/A <br /> ❑ * For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br /> !A <br /> ❑ o* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> Ef N/A or disconnected? <br /> ❑ Yes ❑ o* For elecaunic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br /> Ef N/A malfunctions or fails a test? <br /> Q ❑ o* For electronic LLDs,have all accessible wiring connections been visually i `t <br /> N/A <br /> ❑ No* I Were all hems on the equipment manufacturer's maintenance cheddist completed? <br /> * in the Section H,below,describe bow and when these deficiencies were or will be co <br /> H. Comments: <br /> Page X of 3 oarot <br />