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0nitoring System Certification 0 <br />Site Address: 1442A COLONY DR. <br />F. In -Wank Gauging 1 SIR Equipment <br />Date of Testing/Service: 02/0712011 <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 <br />❑ No' <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />Yes <br />❑ No • <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />0 Yes <br />FINo' <br />Was accuracy of system product level readings tested? <br />QYes <br />❑ No' <br />Was accuracy of system water level readings tested? <br />x Yes <br />❑ No• <br />Were all probes reinstalled properly? <br />EI <br />❑ No' <br />Were all items on the equipment manufacturers' maintenance checklist completed? <br />" In the Section H, below, describe how and when these det[uencies were or will De correctea. <br />G. Line Leak Detectors (LLD) <br />Complete the following checklist: <br />❑ Check this box if LLDs are not installed. <br />Yes ❑ No • <br />❑ NIA <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />(Check all that apply) Simulated leak rate: ® 3 g.p.h D 0.1 g.p.h E]0.2 g.p.h <br />EX Yes ❑ No ` <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />E Yes ❑ No • <br />Was the testing apparatus properly calibrated? <br />Yes ❑ No ` <br />Q WA <br />For mechanical LLDs, does the LLD restrict product Flow if it detects a leak? <br />Q Yes I ❑No • <br />❑ NIA <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />0 Yes ❑No • <br />❑ NIA <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br />Yes ❑No ` <br />❑ NIA <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br />Yes ❑No " <br />❑ NIA <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />Yes ❑No ' <br />Were all items on the equipment manufacturers' maintenance checklist completed? <br />` In the Section H, below, describe how and when these deticiencies were or will oe correctea. <br />H. Comments: <br />Page 3 of 3 Based on CA form dated 03108 <br />