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Monitoring System Certification 0 <br /> Site Address: 2725 COUNTRY CLUB BLVD Date of Testing/Service: 03/24/2010 <br /> F. In-Tank Gauging 1 SIR Equipment <br /> ❑ 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 /> 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 /> 0 Yes ❑No- Were all tank gauging probes visually inspected for damage and residue buildup? <br /> E]Yes Q No Was accuracy of system product level readings tested? <br /> MYes ❑No' Was accuracy of system water level readings tested? <br /> x Yes ❑No` ''+^/ere all probes reinstalled properly? <br /> ❑X Yes 0No' Were all items on the equipment manufacturers'maintenance checklist completed? <br /> In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors (LLD) : ❑ Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> I� For equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance? <br /> Il Yes ❑No- O NIA (Check all that apply)Simulated leak rate: ❑ 3 h 0.1 h 0.2 h <br /> g•P• ❑ g•p- ❑ g�P. <br /> Yes ❑No' Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> Yes ❑No' Was the testing apparatus properly calibrated? <br /> ❑Yes I❑No' Q NA For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> ❑ L <br /> Yes INO- ❑X NIA For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> 0 Yes No' ❑x NIA For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> Yes ❑No' ❑N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> ❑Yes [:]No- Q NIA For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> LJ YeS ❑No' Were all items on the equipment manufacturers'maintenance checklist completed? <br /> 'In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> Page 3 of 3 Based on CA form dated 03108 <br />