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t. In-Tank Gauging f SIR Equlpmwtt ❑ Check thle box 6 tank gauging Loused only for inventory control, <br /> ❑ Check this box 0 no tank gauging or SIR equipment is installed. <br /> This section must be completed if In-tank gauging equipment i$used to perform leak detection monitoring. <br /> Complets the following ehoeklist <br /> UM, <br /> No- Hae all input wiring neon inspected for Proper entry and termination•including tooting for ground faults? <br /> No VVWrc alf tank gauging pry visually for damage and reekdue buiwup? <br /> No" Vitas emu racy of system product level readings tested? <br /> Ne Wits accuracy or system water level readings tested? <br /> No' Weft all probes reinstalled properly? <br /> No' Ware till Rome on the equipment manufacturer's maintenance checklist completed? <br /> ,deacesba how and when these daNelenci"were or wm be corrected. <br /> Line Leak DetWoro(LLDY ❑ Check this box if LLOs are not installed. <br /> cou=the following cho idlat: <br /> ® Yes 0 No' For equipment startup or annual equipment certifications was a Wok slmuleted to verity LLQ performance?(Ctlech eN flat 40Y) <br /> ❑ N/A Simulated leak rate: 0 3 g.p.h.; ❑0.1 g.p.h; ❑0.2 g.p.h. <br /> ® Yee ❑ Ne VMr all LLDa confirmed operational and accurate within regulatory requirements? <br /> ® Yes ❑ No* Was the testing apparatus propwly,calibrated? <br /> ® Yes ❑ No' For mechanl al LLDsr does the LLD restrict productflow if it detects a leak? <br /> ❑ N/A <br /> ❑ yea ❑ No' For dectfonle LLDs,does the turbine eutomtaticelly shut tiff if the LLD detects a leek? <br /> ® NIA <br /> ❑ Yes ❑ No` For-lecti-nio LLOe,does the turbine automatically shut off If any portion of the monhoring system is disabled or dismnnaduJ? <br /> 0 NIA <br /> tortatws9y shut Orf K any pprtion of the monitoring system malfunraiona or tells a test? <br /> L3 Yes 11 Ne For electronic LLDs,does the turbine au <br /> ® NIA <br /> ❑ Yes El N*, For eKcftwic LLDe,have as accessible whine connections bean viwaRy Inspected? <br /> 14 WA <br /> ® Yes ❑ No' Were all Items on the equipment menufacturses maintenance checklist completed? <br /> •In Section H,below,desenbs now and wMn these dsflciwtolae were or w d be cotncted. <br /> H. ew.,eats: ALL 3 LDS PASSED <br /> • C.tO.�r.�1hlr i`�iEif�e�� 1 <br /> PER <br /> iTlGERVr ES <br /> Monitoring System Certifieatlon Page 3 of 3 2/21/07 <br />