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k <br />Monitcri.ng System Certirication <br />Site Address: 40 <br />F. In -Tank Gauging I SER Equiprrtent: <br />0 <br />_ Date ufTestirrg/Servicing: <br />.�J C1ieck this box if tank gauging is used only for inventory control. <br />❑ Check this box if no tank gauging or S1R equipment is installed. <br />This section must be completed if in -tank gauging equipment is used to perform leak detection n-ionitoring. <br />Complete the following checklist: <br />❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />U Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br />❑ Yes ❑ No* Was accuracy of system product level readings tested? <br />❑ Yes ❑ Na* Was accuracy of system water level readings tested? <br />❑ Yes ❑ No* Were all probes reinstalled properly? <br />❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In the Section. H, below, describe Trow and when these defrcieucies were or will be corrected. <br />G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. <br />Complete the following checklist: <br />Yes No* <br />For equipment start-up or annual equipment c tification, was a leak simulated to verify LLD performance? <br />13 N/A <br />(Check all 1lral nppl)fJ Simulated leak rate: l g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. <br />Yes ❑ No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />Yes ❑ No* <br />Was the testing apparatus properly calibrated? <br />Yes ❑ No* <br />For mechanical LLDs, does the LLD restrict product .flow if it detects a leak? <br />❑ N/A <br />Cl Yes ❑ No* <br />I'N/A <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />❑ Yes ❑ No* <br />For electronic LLDs, does the turbine autamatically shut off if any portion of the monitoring system is disabled <br />2( N/A <br />or disconnected? <br />❑ Yes ❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br />Zf N/A <br />malfunctions or fails a test? <br />7 Yes ❑ o* <br />N/A <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />if Yes ❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />In the Section H, below, describe how. <br />and when these deficiencies were or will be corrected. <br />3. Comments; _tE5E L 14p FAt I- <br />