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Site Address: Date of Testing/Servicing: <br />F,,' In -Tank Gauging / SIRE ui t e • <br />t; b 9 P t't• 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 followine checklist: <br />Yes <br />I ❑ <br />No* <br />I Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />14 Yes <br />I ❑ <br />No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />Yes <br />❑ <br />No* <br />Was accuracy of system product level readings tested? <br />Yes <br />❑ <br />No* <br />Was accuracy of system water level readings tested? <br />Yes <br />❑ <br />No* <br />Were all probes reinstalled properly? <br />Yes <br />❑ <br />No* <br />1 Were all items on the equipment manufacturer's maintenance checklist completed? <br />ue uec occuvu n, ucouw, UCSCUIuc nVw anu wnen uoese ueviciencies were or wai be corrected. <br />G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. <br />Eornplete the following checklist: <br />es <br />LJ No* <br />For equipment start-up or annual equipnte t certification, was a leak simulated to verify LLD performance? <br />❑ N/A <br />(Check all that apply) Simulated leak rate: M 3 g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. <br />Yes <br />❑ No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />Yes <br />❑ No* <br />Was the testing apparatus properly calibrated? <br />Yes <br />❑ No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ N/A <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />Xf N/A <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />N/A <br />or disconnected? <br />❑ Yes <br />L❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br />N/A I <br />malfunctions or fails a test? <br />❑ Yes <br />E3 No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />N/A <br />Yes <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />_-- __-_ --, ,.—.,, ..� .............. ...... ....0 .a ..- ..Iauc UIM Va VVVI c ur will ve correcteu. <br />K. Comments: <br />