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Monitoring System Certification <br />REGEIVEC <br />F. In -Tank Gauging f SIR Equipment., A Check this box if tank gauging is used only for ittr/ellCo4 1"15 <br />0 Check this box if no tank gauging or STR equi installed. <br />ENTAL <br />This section must he completed if in -tank gauging equipment is used to perform leak detection _ _ _O, -..r -^,T <br />Complete the following checklist: <br />Q Yes ] No* I Has all input wiring been inspected for proper entry and termination, including testing fpr ground faults? <br />[j lyes Ci No* were all tank gauging probes visually inspected for damago and residue buildup? <br />Q yes No* Was accuracy of system product level readings tested? <br />�] <br />yes a No* Was accuracy of system water level readings tested? <br />] Yes Q No* were all probes ruinstalled properly? <br />❑ Y4s ❑ No' Were all items on the equipment manufacturer's maintenance checklist completed? <br />w in section N, below, describe how and when these deficiencies were or will be corrected. <br />G. Lime Leak Detectors (LLD): <br />Yes <br />j Yes <br />© Check this box if LLDu are not Installed. <br />the f9iloWjnlj rnecKn9U <br />For cNuipmeot start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />[] No* <br />Check. ull that apply) simulated leak rate, i( 3 g•p•h•; 0 0.1 g.p,b ; CI 0-2 g•p.h. <br />Q N/A ( <br />CI No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br />4 -Yes 10 No* <br />Yes <br />© No* <br />(:] N/A <br />{� Yes <br />❑ No"' <br />it NIA <br />p Yes <br />iYl No* <br />�} NIA <br />(] Yes <br />0 No <br />(f NIA <br />p Yes <br />Q No* <br />{, N/A <br />Y <br />❑ No' <br />Was the testing apparatus properly calibrated? <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />For electronic LLDs, docs the turbine automatically shut off if the LLD detects a icak? <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />ctconLL Ds, oes th <br />or disconnected? r scop de turbinc automatically shut off if any portion of the monitoring system malfunctions <br />elect <br />or fails a test? <br />For clectronic LLDs, have all accessible wiring connections been visually inspected? <br />eS <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />w In Section N, below, describe how and when these dcfieieucies were or will be corrected. <br />H. Comments, <br />page 3 of 4 <br />Rev. 01/17/tlt! <br />W",UdWnCA.orP. <br />1W.nu VJ6 <br />�_S'd M7289t7:01 96ZTTRS6O2 3JNHI1dW03 1SO:WOdJ O2" -9T ST02-2-Ndf <br />