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06/03/2015 10:15 8387674 EMILS PAGE 12 <br /> F. ImTenk Gauging/51R Equipment N Check this box if tank gauging it <br /> USCO OdlytOr iECE�VE <br /> ❑ Check this box it no tank gauging or SIR equipment is instteNed. <br /> This Seedgrl must be completed Ir In-tank gauging equlpmant Is used to perform leak detection monitoring. JUN 0 3 2015 <br /> Completethe following checklist; <br /> ® Yes ❑ No' Has all input wiring been inspected far proper entry and termination,1nrJudingfeeling for ground faults? 1JC . T/4l <br /> A u r <br /> N Yes ❑ No• Were an tank gauging probes visually,Impeded for damage and residue buildup? hlT <br /> ® Yes ❑ No' Was accuracy of system product levelresdingstesoetl? <br /> N Yes ❑ Nc' Was accuracy of system water level readings tested? <br /> N Yea ❑ No` Ware all probes reinstalled property? <br /> N Yes ❑ NO' were all item soniheequlpmammanufaclurer'smmimenancecrlecklist Compleiatl7 <br /> In Section H,below,-do— I how and when these deficiencies Were Or will be corrected. <br /> Line Leak Detectors 11-1-Dy ❑ Check dile box It LLDS are not Installed. <br /> complete the follo mr-9 checklHC <br /> ® Yes ❑ No' For equipment Stad.up or annual equipment cedificaWn, was a leak simulated to verily LLD performance? (Check all that apply) <br /> ❑ WA Simulated leak rate: N 3 g.p.h.; ❑0,1 g,p,b; ❑0.2 g.p.h. <br /> ® Yes ❑ No, Were all LLDS confirmed operational and accurate Wine,regulatory requirements? <br /> N Yes ❑ NM Wythe tasting apparatus property celSbrele0? <br /> ® Yes ❑ NO' For Mechanical LLDS.does the LLD restrict product flow 9i detects a leak? <br /> ❑ NIA <br /> ❑ Yes ❑ NO' For eleWonlc LLDS,does the turbine OVIOmadCally shut off if the LLD detects a leak? <br /> N WA <br /> ❑ Yea ❑ NO' FOr elecsenic LLDS,does the WrbinB aulpmadcally shut off if any potion of the monitoring system is disabled or disconnected? <br /> N WA <br /> ❑ Yes ❑ No, For electronic LLDa,dobe the fumma automadwlty shut ort d any penton oryb0 monitoring system malfunctions or fails a test? <br /> N NIA <br /> ❑ Yes ❑ NO' For electronic LLD.•have all accessible wiring connections been visually Inspected? <br /> N WA <br /> 19 Yes ❑ No' Were all items an the equipment manufacturers maintenance Checklist Completed? <br /> In Section H,below,describe how and when these deficiencies were or will be corrected. <br /> I. Comments: <br /> Monitoring System Certification page 3 OFAI 2r21/07 <br />