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• <br />Site Address: <br />F. In -Tank Gauging / SIR Equipment: <br />Li <br />❑ Chak this box if tank pupng is used only for inventory control. <br />❑ Check this box if no ng or SIR equipment is installed. <br />• "AI• _. ( �f.'. t rm-ebrrnleakdetectionnionitonng. <br />a? 1 --A--LTTiT4 I k <br />I■ l ;: a a` I W : f u f t 1------ <br />l a <br />■ ..+a ;, t . u _ AIw ws f l " r.f r <br />%r� :ti. ■ i �" 11 r k at Y I t , IN it .F I n+l : Y :, r,! al ri i:' :•/ _ _ _ __ <br />i7i <br />i TILL, I- <br />=7 t 1 1" w �Y: <br />G. Line Leak Detectors (LLD): <br />vMMM140 the falkwing e " <br />t�I • �: <br />■ i <br />i equipment:; IU or : :.1 Y a t: 111 M,. 1 I +... ;:, :.asimulated 1Vol* 1,'. / 1 `...a' <br />0 N/A <br />(check all that apply) Siranlated leak rate: e3 g.p.h. 1; 0 0. 1 g.p.h . <br />Notes: Required for equipment 1 start-up a-.r.M/ tNi.-h and annual certification. <br />Unlessii : 1.1:t wP. 1y local required rf M.t. Y; electronicr1 <br />�.....L;'�� r...` <br />■ , y <br />. � NI 1 ! r vl i t m i ! 'l Z 1 i N ' : J' +�' #. ! f Fl ' <br />y ++....... <br />■ i <br />1 i 's N: :. 1. D ' ' - �. by t i i i ' i ' t....; w✓ <br />■ <br />INION <br />r is t' Y detects leak? <br />For 1 t► r D` does (- fautomatically t <br />i <br />frj <br />■ 1'1 <br />{. .Nt it �' IFS.+: L' i.. f i :.:Y w: ti C i'1:. t1. t'. r ra..p. t...� -:1. f ;5 1 ri <br />n <br />� : a9I 11'I•;r �, <br />■ ;, <br />■ t,t <br />t t t is sf:. l :r✓,' t ti r Rt ♦ l ft r 1' :+rt <br />r`: <br />■ t <br />1. - 1"'! # . .. - . 7; t - + jt al <br />. <br />t�i.. <br />■ f <br />'- r it t l r' +`i 1 P t t 11 <br />heli. 1Yii IYR...1►i.` a T'Ti(±(`Tai'ili.ltt�r'xi3rc.:wr1� <br />H. Comments: <br />Page 3 -of 3 03/01 <br />