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0 <br />F. In-Tdnk Gauging /'SIR Equipment tr-C-heck this box if tank gauging is used only for inventory control. <br />Q Check this box if no Lank gauging or SIR 'equipment is installed. <br />ae <br />This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring, <br />('arnnipto the fallawina rhPPkHrat- <br />0 Yes <br />Q No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />Q Yes <br />Q No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />0 Yes <br />0 No* <br />Was accuracy of system product level readings tested? <br />0 Yes <br />0 No* <br />Was accuracy of system water level readings tested? <br />Q Yes <br />I U No* <br />Were all probes reinstalled properly? <br />Q Yes <br />JQ _No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />In the Section K below, describe how and when these deficiencies were or will be corrected. <br />G. Line Leak DeterAors (LLD); Q Check this box if LLDs are not installed. <br />P,mmnWo thm- MUnwina phpoHiat- <br />Yes <br />U No* <br />Q N/A <br />For equipment start-up or annual equipment 5ceaffication, was a leak simulated to verify LLD performance? <br />(Check all that apply) Simulated leak rate: U3 g.p.h.; U 0.1 gp.h; U 0.2 g.p.h. <br />Z'Yes <br />Q No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />Zf 'Yes <br />Q No* <br />Was the testing apparatus properly calibrated? <br />RrYes <br />Q No- <br />0 N/A <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak.? <br />• Yes <br />0 No* <br />EKN/A <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak?. <br />• Yes <br />U No* <br />O"N/A <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />or disconnected? <br />• Yes <br />12 No* <br />QrNIA <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions <br />or fails a test? <br />;QLYesUNo* <br />� <br />LT N/A <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />Yes <br />U No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />4' In the Section K below, describe how and when these deficiencies were or will be corrected. <br />H. Co ants; <br />Page 3 of 3 03/01 <br />