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F. In-Tank Gauging/SIR Equipment: ® Check this box if tank ga is used only for inyent,_orX y <br /> ❑ Check this box if no tank gauging or SIR equipmShTW, s�V 111� <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. - 1C <br /> Complete the following checklist: JUN 2 U 2016 <br /> Ell" Has all input wiring been inspected for proper entry antl termination,inclutling testing for grountl faults?' Were all tank gauging probes visually inspectetl for damage antl resitlue 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?Were all items on the equipment manufacturer's maintenance checklist completed? <br /> In Section H,below,describe now and when these deficiencies were or will be corrected. <br /> .ine Leak Detectors(LLD): ❑ Check this box if LLDs are not installed. <br /> Com late the followin checklist: <br /> ® Yes ❑ No' For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) <br /> ❑ N/A Simulated leak rate: ®3 g.p.h.; ❑0.1 g.p.h; ❑0.2 g.p.h. <br /> ® Yes ❑ No" Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> ® Yes ❑ No" Was the testing apparatus property calibrated? <br /> ® Yes ❑ No' For mechanical LLDs,does the LLD resMct product flow if it detects a leak? <br /> ❑ N/A <br /> ❑ Yes ❑ No' For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ® N/A <br /> ❑ Yes ❑ No' For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> ® N/A <br /> ----------------- <br /> ❑ Yes ❑ No' For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails at <br /> test? <br /> ® N/A <br /> ❑ Yes ❑ No" For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> ® N/A <br /> ® Yes ❑ No" Were all items on the equipment manufacturer's maintenance checklist completed? <br /> In Section H,below,describe how and when these deficiencies were or will be correctetl. <br /> H. Comments: <br /> ALL 3 LDS PASSED <br /> Monitoring System Certification Page 3 of 4 2/21/07 <br />