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{. In-Tank Gauging 1 SIR Equipment: <br /> N Check this box if tank gauging is used only r invetoryis contr l <br /> Ej Check this box if no tank gauging or SIR equipment <br /> equipment is used to perform leak detection monitoring <br /> his section must be completed if in tank gauging <br /> f 19 Yes ❑No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> ®Yes 0 No* ere all tank-gauging probes visually inspected for damage and residue buildup? <br /> ®Yes []No* as accuracy of system product level readings tested? <br /> Ig Yes ❑N o* as accuracy of system water level readings tested? <br /> M Yes ❑No* ere all probes reinstalled properly? <br /> ®yes [j No* ere all Items on the equipment manufacturers maintenance checklist completed? <br /> Check this box if Leak Detectors are not installed. <br /> G.Line Leak Detectors (LLD): <br /> Complete the following checklist <br /> yes ❑NIA For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? <br /> d No* (Check all that apply)Simulated leak rate: [Iwithinwithin regulatory requirements? <br /> GPM; []0.2 GPH; 0 4.1 GPH <br /> []Yes [I No* ere all LLDs confirmed operational and accurate <br /> yes []NO* as the testing apparatus properly calibrated? <br /> Yes [I NIA For mechanical LLDs,does the LLQ restrict product flow if it detects a leak? <br /> ©No* <br /> 0 yes i]NIA For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> No* <br /> 0 <br /> Yes ❑NIA For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disable <br /> ❑ <br /> ❑No* r disconnected? portion of the monitoring system malfunctions or fails a <br /> El Yes ©NIA For electronic LLDs,does the turbine automatically shut off if any <br /> F1 No* est? <br /> yes [3 NIA For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> ©No* <br /> �Yes {]No* ere ail items on the equipment manufacturers maintenance checklist comple#ed <br /> * In section H below,descnb$how and when these deficiencies were or wi31 be corrected: <br /> $.Comments: <br /> i <br /> , <br /> i <br /> 3101 <br /> Monitoring System Certification <br /> page 3 of 3 <br />