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Monitoring system Certification <br />F. in -Tank Gauging / SIR Equipment: Cheok this box if tank guugarg is used only for inventory control. <br />Check tluis 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 dctection monitoring, <br />Cawplete the f011nwing checklist: <br />FesOYes❑ No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground Faults? <br />❑ No* <br />Were all tau& gaug,iub prubcs visually inspected for damage and residue buildup? <br />❑ Yes p No* <br />Was accuracy of system product level readings tested? <br />0 Yes ❑ No* <br />Was accuracy of system water level readings tested? <br />❑ Yes ❑ No* Were all probes reinstalled properly? <br />❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br />In Soction K below, describe bow and when the3c dercicucics were ov Will be c'urrmted. <br />G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. <br />Com lett the foil ing checklist: <br />1 Yes ❑ No* For equipment start-up or annual equipment certificatioa, was a beak simulated to verify LL <br />performance? <br />❑ N/A (Check all that apply) Simulated leak rate: 0 3 g.p h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. <br />Ycs <br />❑ No* <br />Werc all LLDs uuuiiru cd uptrutiwW, and accurate within regulatory requirements? <br />1 Yes <br />❑ No* <br />Was the testing apparatus properly calibrated? <br />�J Yes <br />❑ No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a lett? <br />❑ N/A <br />El Yes <br />❑ NO <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />N/A <br />❑ Ycs <br />0 No* <br />For electronic LLDs, does the turbine automatically shut orf if any portion of the monitoring sys <br />ra is disabled <br />N/A <br />or disconnected? <br />❑ Yes <br />❑ Not <br />For electronic LLDs, docs the turbine automatically shut off if any portion of the monitoring system <br />malfunctions <br />N/A <br />or fails a test? <br />© Yes <br />❑ No* <br />For eleotronic LLDs, hayo all accessible wiring couuc-uLiuus been visually inspected? <br />Uf N/A <br />Yea <br />❑ No* <br />Were all items on the equipment manufwhrrer's maintanance checklist completed? <br />fn Section <br />H. below. <br />describe hew and when theca ri-A..aooioe <br />UN -036 - 3/6 <br />90/to 39hd <br />Page 3 of 4 <br />www.nnidoes.org <br />tI00d Stirs IM 7 <br />ReV, 01/17108 <br />9L9L9985o7_, bZ:9T=.To%/T.-i'•T <br />