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ANoYcring System Certification Site Address: IS 3?j U oh u ?I Date of Testing/Servicin F. In-Tank Gauging/SIR Equipment: Check this box if tank gauging is used only for inventory control. ❑ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform lcalc detection monitoring. Complete the following checklist: OEQIYes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? ❑ No* Was accuracy of system product level readings tested? ❑ No* Was accuracy of system water level readings tested? ❑ Yes ❑ No* Were all probes reinstalled properly? ❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. Co tete the ollowing checklist: Yes o* For equipment start-up or annual equipme rtification, was a leak simulated to verify LLD performance? N/A (Check all apply) Simulated leak rat; 3 g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. YY No* Were all LLDs confirmed operational and accurate within regulatory requirements? Yes ❑ No* Was the testing apparatus properly calibrated? es o* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ N/A ❑ Yes ❑ * For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? N/A ❑ Yes ❑ NO* LFor ectronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled N/Aonnected? ❑ Yes ❑ No* lectronic LLDs, does Ilse turbine automatically shut off if any portion of the monitoring system N/Actions or fails a test? ❑ Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? N/A Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe flow and when these deficiencies were or will be corrected. H. Comments: �OT� I ESEI' GA'so `5 F4 ss .