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Monitoring System Certification <br /> F. In-Tank Gauging/SIR Equipment: ] Check this box if tank gauging is used only for inventory control. <br /> ❑ Check this 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 detection monitoring. <br /> Complete the following checklist: <br /> ❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> ❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ❑ Yes ❑ No* Was accuracy of system product level readings tested? <br /> ❑ Yes ❑ No* 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 checkli c <br /> *In Section H,below,describe how and when these deficiencies were or will be corrected. DEC 19 2017 <br /> G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. <br /> ENVIRONMENTAL HEALTH <br /> Complete the following checklist: !:)r-r- QT.n i7tIT <br /> Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br /> ❑ N/A (Check all that apply) Simulated leak rate: g3 g.p.h.; [10.1 g.p.h; ❑0.2 g.p.h. <br /> {g1 Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> Yes ❑ No* Was the testing apparatus properly calibrated? <br /> Rf Yes ❑ No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> ❑ N/A <br /> L ❑ No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> N/A <br /> ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> N/A or disconnected? <br /> ❑ No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions <br /> N/A or fails a test? <br /> ❑ No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> 0 N/❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> *In Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> Page 3 of 4 <br /> UN-036—5/6 www.unidocs.org Rev.01/17/08 <br />