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Monitoring System Certification <br /> ALSite Address: r Date of Testing/Servicing /�/� <br /> F. In-Tank Gauging/ SIR Equipment: ❑ Check this box if tank gauging is used only for inventory'control. <br /> ❑ Check this box if no tank gauging or SIR equipment is installed. <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. . <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 /> ❑ 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 /> 0 Yes '❑ No* Was accuracy of system water level readings tested? <br /> 13 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 how and when these deficiencies were or will be corrected. <br /> G. Line Le k Detectors (LL G Check this box if LI..Ds:ire not installed. <br /> Complete the following checklist: <br /> ❑ Yes ❑ NO For equipment start-up or annual equipment certification,. was a leak simulated to verify LLD performance? <br /> ❑ N/A (Check all that apply) Simulated leak rate: ❑ 3 g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. r• r <br /> • Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? t <br /> ❑ Yes ❑ NO Was the testing apparatus properly calibrated? <br /> © Yes ❑ No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> ❑ N/A <br /> 0 Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ❑ NIA <br /> ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring systornjs disabledt <br /> ❑ NIA or disconnected? <br /> ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br /> ❑ N/A malfunctions or fails a test? <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 the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> Page 3 of 3 05!00 <br />