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F. In-Tank Gauging I SIR Equipment: ® Check this box If tank gauging is used only for inventory control. <br /> ❑ Check this box It 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 /> ❑ Yes ❑ No' Was accuracy of system water level readings tested? <br /> ❑ Yes O No' Were all probes reinstalled properly? <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 corrected. <br /> LLM Leak Detector(LLD): ❑ Check this box if LLDs are not Installed. <br /> Complete the followina checklist: <br /> ® Yes ❑ No' For equipment start-up or annual equipment certification,was a leek simulated to verify LLD performance?(Check all that apply) <br /> ❑ WA Simulated leak rate: ®3 g.p.h.; [10.1 g.p.h; ❑02 g.p.h. <br /> ® Yes ❑ Ni Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> ® yes ❑ No' Was the testing apparatus properly calibrated? <br /> ® Yes ❑ NW For mechanical LLDs,does the LLD restrict product flow if It detects a leak? <br /> ❑ WA <br /> ❑ Yes ❑ No' For electronic LLDs.does the turbine automatically shut on if the LLD detects a leak? <br /> ® N/A <br /> ❑ Yes ❑ No' For electronic LLDs,does the turbine automatically shut oft g any potion of the monitoring system Is disabled or disconnected <br /> ® WA <br /> ❑ Yes ❑ No' For electronic LLDs,does the turbine automatically shut off N any portion of the monitoring system malfunctions or fails a test? <br /> ® WA <br /> ❑ Ves ❑ Ni For electronic LLDs,have all accessible wiring connections been visually Inspected? <br /> ® WA <br /> ® Yes ❑ No' Were all items on the equipment manufacturers maintenance checklist completed? <br /> -In Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> JTtGE- --. - - _ - teas/ <br /> UFr-- _ 20 0017 <br /> - - <br /> ENTAL HEALTH <br /> ENT <br /> Monitoring System certification pa"3 of 4 2/21/07 <br />