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I . 0 6 <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 following checklist: "- <br />- In aecti-ii 11, oerow, oescrioe now ana wren ureses uenGrer. —1 1 wm <br />Line Leak Detectors (LLD) ❑ Check this box if LLDs are not installed. <br />® Y s <br />Yes <br />❑ <br />No' <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />• <br />Yes <br />❑ <br />No' <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />® <br />Yes <br />❑ <br />No' <br />Waa accuracy of system product level readings tested? FEB 26 2 <br />© <br />Yes <br />❑ <br />l' -' <br />Was accuracy of system water Level readings tested? <br />• <br />Yes <br />❑ <br />No' <br />Were all probes reinstalled properly? <br />l <br />Yes <br />❑ <br />F: c' <br />Were all items on the equipment manufacturer's maintenance checklist completed? ®� "��®L <br />- In aecti-ii 11, oerow, oescrioe now ana wren ureses uenGrer. —1 1 wm <br />Line Leak Detectors (LLD) ❑ Check this box if LLDs are not installed. <br />® Y s <br />❑ <br />f : `Fo <br />equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) <br />❑ <br />N/A <br />Simulated leak rate: ®3 g.p.h ; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. <br />® Ycs <br />❑ <br />;do' <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />❑ Yes <br />Vvas the testing apparatus properly calibrated? <br />[ j [ <br />Fur mechanical U Es, does the LLJ restrict pi oduct flow if it detects a leak? <br />_ <br />A <br />Y <br />For e ectr< LLDs, does the tura re automatically shut off if the LLD detects a leak? <br />l <br />c' <br />Fere :-ctronic LuD_, does the .ui b ",e automatically shut off if any portion of the monitoring system is disabled or disconnected? <br />L <br />N ;1 <br />Fc.: mac, ^nic LLDs, does the turbu,e automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br />N <br />F, .,.!:onic LLC_s, have all :cc Bible wiring connections been visually inspected? <br />❑ <br />P /A <br />Yes ] <br />V.'(,re all items on the equipment manufacturer's maintenance checklist completed? <br />.c. Le I,_ -a id when these deficiencies were or will be corrected. <br />H. Cernr�e^+s: <br />P.',n:f-ring Systo - ­ rtificati-:.. Page 3 of 4 2/21/07 <br />