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Site Address: Date of Testing/Servicing: le <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 installed. <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. <br /> Complete the foilowing-checklist: <br /> [3-yes 1 0 No* Has all input wiring been Wspected for proper entry and termination,including testing for ground faults? <br /> Eff'�Yes [I No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> MO'Yes. 0 No* Was accuracy of system product level readings tested? <br /> ®'Yes [I No* Was.accuracy of system water level readings tested? <br /> Yes 0 No* Were all probes reinstalled properly? <br /> Er Yes [I No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> In the Section X below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors (LLD): 0 Check this box if LLDs are not installed. <br /> Complete the loll checklist: <br /> ( Yes 0 No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br /> 0 NIA (Check all that apply) Simulated leak rate: 591g.p.h.'; 00.1g.p.h.2; El 0.2 gp.h.2 <br /> Notes: 1. Required for equipment start-up certification and annual certification. <br /> 2. Unless mandated by local agency,certification required only for electronic LLD start-up. <br /> EVY es. 0 No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> R-Se_s M No* Was the testing apparatus properly calibrated? <br /> 2,,Ifes C] No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> 0 N/A <br /> 0 Yes 0 No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> R(N/A <br /> n Yes M No* For electronic LLDs,does the turbuic automatically shut off if any portion of the monitoring system is disabled <br /> ®''N/A or disconnected? <br /> 0 Yes 0 No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br /> Ur NIA malfunctions or fails a test'! <br /> 0 Yes 0 No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> ar'Yes [3 No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> In the Section%below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> Page 3'of 3 03101 <br />