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n9onitcring System Certification • • <br /> •Site Address: 11 11� 0� �t� �Y - _ Date of Testing/Servicing: <br /> 'F. In-Tank Gauging/SIR Equipment: El­'(:!b_eck 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 /> ❑ Yes ❑ No* Was accuracy of system water level readings tested? <br /> ai ❑ No* Were all probes reinstalled properly?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 Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> es ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br /> ❑ N/A (Check all chat apply) Simulated leak rate: �h.; 130.1 g.p.h ; 130.2 g.p.h.OY <br /> es j ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> es ❑ 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 /> a—ITFA— <br /> ��Tes_ ❑ No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ❑ N/A <br /> es ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> N/A or disconnected? <br /> es ❑ 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 /> U'Ves ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? <br /> /A <br /> U-Ves� ❑ 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 />