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Y <br />F. In -Tank Gauging / SIR Equipment: [9 Check this box if tank gauging is used only for inventory control. <br />❑ Check this box if no tank gauging or SIR equipment is ins UM -Q I 2016 <br />This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. <br />Cmmnlete the fnllnwinn checklist: <br />❑ <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 />Was accuracy of system product level readings tested? <br />❑ <br />Yes <br />❑ <br />No* <br />Was accuracy of system water level readings tested? <br />❑ <br />Yes <br />❑ <br />No* <br />Were all probes reinstalled properly? <br />❑ <br />Yes <br />❑ <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 />G. Line Leak Detectors (LLD): ED Check this box if LLDs are not installed. <br />rmmnlata tha fnllnwinn rhark1ict- <br />1Y <br />Yes <br />❑ <br />No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all <br />❑ <br />N/A <br />that apply) Simulated leak rate: [B3 g.p.h.; [00.1 g.p.h ; 00.2 g.p.h. <br />1Y Yes <br />❑ <br />No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />Or <br />Yes <br />❑ <br />No* <br />Was the testing apparatus properly calibrated? <br />13 <br />Yes <br />❑ <br />No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ <br />N/A <br />❑ <br />Yes <br />❑ <br />No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />N/A <br />❑ <br />Yes <br />❑ <br />No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or <br />IB <br />N/A <br />disconnected? <br />❑ <br />Yes <br />❑ <br />No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or <br />R <br />N/A <br />fails a test? <br />❑ <br />Yes <br />❑ <br />No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />C3 <br />N/A <br />C3 <br />Yes <br />❑ <br />No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />- In ine Secuon H, Mow, aescrloe now ana wnen mese aenclencles were or wiii De correctea. <br />H. Comments: <br />Monitoring System Certification Page of 12/07 <br />