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M onitoring System Certification - Page 3 of 3 JUL 15 2016 <br />-�...n,0 " `rt=- 1_9teAddrem 1409 S. Airport Way �7stEbf illg/Sevicing: 6116116 <br />F. In -Tank Gauging/SIR Equipment: <br />® Check this box if tank gauging is used only for inventory control. <br />❑ Check this box if notank gauging orSlRequipment isinstelled. <br />This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. <br />Comoletethe fclowina checklist: <br />❑ Yes <br />❑ <br />No* <br />Has all input wirirg been inspected for proper entry end termination, irid uding testi rig for ground failts? <br />❑Yes <br />❑ <br />No* <br />Were Ed I tank gaugi rig probes visually inspected for damage and residue bui Idup? <br />❑Yes <br />❑ <br />No* <br />Was accuracy ofsystem product level readings testec? <br />❑ Yes <br />❑ <br />No* <br />Was accurayofsystem water leael read ngstested? <br />❑ Yes <br />❑ <br />No* <br />Wereeil probes reinstalled properly? <br />❑ Yes <br />❑ <br />No* <br />Were alI items on the equipmehtmanufacturer's mai ntehanoecheck Iistoompleted? <br />* I n Section H below, describe how and when these deficiencies were or will be corroded. <br />G. Line Leak Detectors(LLD): ❑ Check thisboxifLLD'saenotinstalled. <br />Comolete the fctowina checklist: <br />®Yes <br />❑ No* <br />Forequipment start-uporannual equipment certification wasaleek simulated to verify LLD performonce? <br />❑ N/A <br />(Checkall that apply) Simulated leek rate: ® 3 g.p.h. (1.); ❑ 0.1 g.p.h. (2); n 0.2 g.p.h. (2.). <br />Notes 1. Required for equipment start-up certification andannualoetifiration. <br />2. Unless mandated by local agency, certification required only for electronic LLD stat -up. <br />® Yes <br />❑ No* <br />Wereall LLD'sconfinmed operational and accurstewithin regulatory requirements? <br />®Yes <br />❑ No' <br />Wasthetestingappaatusproperlycalibrated? <br />® Yes <br />❑ No' <br />For mechanical LLD's, doesthe LLD restrict productflaw if it detedsa leek? <br />❑ N/A <br />❑Yea <br />❑ No' <br />For dedronicLLD's, does the turHneautomaticallyshut off iftheLLDdetedsaleek? <br />® WA <br />❑Yes <br />❑ No* <br />For electrcnicLLD's, does the turbine automatically shut off if any portion of themonitoring system isdisabled <br />® N/A <br />I ordisconnetei? <br />❑ Yes <br />❑ No* <br />For electronic LLD'$ does the turbineautorrndically shut off if any portion of themonitoring system <br />N WA <br />malfunctions orfails atest? <br />[i Yes <br />❑ No* <br />For electronic LLD's, haveall accessible wiring connections been visually inspected? <br />0 N/A <br />® Yes <br />❑ No' <br />Wereall item ontheeauipmetmanufactureesmaintenanechecklist completed? <br />* I n Section H below, describe how and when thew deficiencies were or will be oorreded. <br />H. Comments <br />