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a <br />F. In -Tank Gauging/ SIR Equipment: <br />❑ 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: 9 <br />❑ Yes <br />❑ <br />No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? i <br />❑ Yes <br />❑ <br />No* <br />I 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 />'"'ere all items on the equipment manufacturer's maintenance checklist completed? <br />* In the Section H, below, describe how and when these deficiencies were or will be corrected. <br />G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not -installed. <br />Cor_inlete the fn11mvina t-herL-IRt- <br />Yes <br />❑ No* <br />For equipment start-up or annual equipment certification, syas a leak simulated to verify LLD performance? <br />❑ N/A <br />(Check cli that apph) Simulated leak rate: &13 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 />I ❑ 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*A <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />2-N /.,k <br />I <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />O'—N—/A I <br />or disconnected? <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitorins system <br />y <br />2-1�1_/A <br />malfunctions or fails a test? <br />❑ Yes <br />❑ No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />0­11V/A <br />Yes <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In the Section H. below, describe how and when these deficiencies were or will be corrected. <br />H. Comments: K_ 7-A�7-1&N Po,2,`-t P6 <br />I �/3 t 1. -ems' � Lr ti :F-- L.,��',4-lC !� �•T�'e-7`a2 s <br />Page 3 of 3 <br />03!01 <br />