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❑ Check this box if no taning or SIR equipment is installed. <br />This section must be completed if in -tank gauging equlpment is used to perform leak detection monitoring. <br />Complete the following checklist: <br />In Section H, below, describe In <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />Were ail tank gauging probes visually inspected for damage and residue buildup? <br />Was accuracy of system product level readings tested? <br />Was accuracy of system water level readings tested? <br />Were all probes reinstalled properly? <br />Were all items on the equipment manufacturers maintenance checklist completed? <br />and when these deficiencies were or will ba corrected. <br />Check this box if LLDs are not installed. <br />checklist: <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) <br />Simulated leak rate: ® 3 g.p.h.; ❑ 4.1 g.p.h ; ❑ 0.2 g.p.h. <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />Was the testing apparatus properly calibrated? <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />and when these deficiencies were or will be eorrectPri <br />H. Comments; <br />DSL 130 3 28 14 PASS <br />0 � 2014 <br />Monitoring System Certification Page 3 of 4 2/21/07 <br />followi <br />* <br />❑ No* <br />NfA❑ <br />* <br />FCome <br />No' <br />No* <br />tYe <br />N!A <br />No* <br />NIA <br />No* <br />In Section H, below, describe I <br />Jne Leak Detectors (LLD): <br />N/A <br />In Section H, below, describe In <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />Were ail tank gauging probes visually inspected for damage and residue buildup? <br />Was accuracy of system product level readings tested? <br />Was accuracy of system water level readings tested? <br />Were all probes reinstalled properly? <br />Were all items on the equipment manufacturers maintenance checklist completed? <br />and when these deficiencies were or will ba corrected. <br />Check this box if LLDs are not installed. <br />checklist: <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) <br />Simulated leak rate: ® 3 g.p.h.; ❑ 4.1 g.p.h ; ❑ 0.2 g.p.h. <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />Was the testing apparatus properly calibrated? <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />and when these deficiencies were or will be eorrectPri <br />H. Comments; <br />DSL 130 3 28 14 PASS <br />0 � 2014 <br />Monitoring System Certification Page 3 of 4 2/21/07 <br />followi <br />❑ No* <br />NfA❑ <br />FCome <br />No' <br />No* <br />No* <br />N!A <br />No* <br />NIA <br />No* <br />N/A <br />No* <br />NIA <br />No* <br />N/A <br />No* <br />In Section H, below, describe In <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />Were ail tank gauging probes visually inspected for damage and residue buildup? <br />Was accuracy of system product level readings tested? <br />Was accuracy of system water level readings tested? <br />Were all probes reinstalled properly? <br />Were all items on the equipment manufacturers maintenance checklist completed? <br />and when these deficiencies were or will ba corrected. <br />Check this box if LLDs are not installed. <br />checklist: <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) <br />Simulated leak rate: ® 3 g.p.h.; ❑ 4.1 g.p.h ; ❑ 0.2 g.p.h. <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />Was the testing apparatus properly calibrated? <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />and when these deficiencies were or will be eorrectPri <br />H. Comments; <br />DSL 130 3 28 14 PASS <br />0 � 2014 <br />Monitoring System Certification Page 3 of 4 2/21/07 <br />