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U Cb=k this box if no tank gauging or SIR equipment is installecl. <br />T'PjOVWNb0II ga—'IiM OWGI <br />This 'seW6n must be completed if in -tank gauging equipment is used to perform leak detection monitoring, <br />Comolete the followirw cheeldW; <br />U Yes <br />0 No* <br />Has all input wiring been lusl=ted for proper entry and ternAnation, including testing for ground faults? <br />E3 Yes <br />0 No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />M Yes <br />E3 NoP <br />Was accuracy of system product level readings tested? <br />Yes <br />Q No* <br />Was accuracy of system water level readings tested? <br />Q Yes <br />13 No* <br />Were all probes reinstalled property? <br />ZI !Yes <br />❑ No' <br />re <br />Weall items on the equipment manufactwer's maintenance dbacklist co ? <br />completed? <br />* In the Section H, below, describe how and wbea these deficiencies were or will be corrected. <br />G. Line Leak Detectors (LLX))-. 0 Check this box if LLDs are not installed, <br />Complete the followine checldft <br />E3 Yes <br />0 No* <br />For equipment start up or annual equipincut certi&ation, was a leak simulated to 'verify UD peiformanx? <br />U N/A <br />(Check all that apply) Simulated leak rate: 13 3 g.p.IL; U 0.1 g.p.h; Ll 0.2 g.p.h. <br />13 Yes <br />11 No* <br />Were all LLDs conOrmed operational and accurate within regulatory mquiremnW9 <br />El Yes <br />E3 No* <br />Was the testing apparatus property calbrated-) <br />E3 Yes <br />0 No* <br />For mecbavical LLDs, does the LLD restrict product flow if it detects a leak? <br />El N/A <br />11 Yes <br />El No* <br />For electronic LLDs, does the twbinc automatically shut off if the LLD detects a leak? <br />0 N/A <br />0 Yes <br />U No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />E3 N/A <br />or disconnected? <br />13 Yes <br />U No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br />E3 N/A <br />malfunctions or fails a test? <br />C] Yes <br />U No* <br />For electronic LLDs, have all aooemble wiring commdons been visually inspected? <br />0 NIA <br />10 Yes <br />13 No* <br />Were all item on the equipment mam6cames maintenance checklist completed? <br />* In the Section H, below, describe bow and when these deficiencies were or will be corrected. <br />EL Comments: <br />AIDC*PfyTrA(- (,(,6S � *7rgri) <br />