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0 <br />0 <br />F. In Tank Gauging f SIR Equipment X Check this box if tank gauging is used only for inventory control. <br />❑ Check this box N no tank gauging or SRR equipment is installed. ate— ■� <br />This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. RECEIVED <br />_J L ` C a q <br />CemMars rhCENinwlM chu4rliM• "�lG G Gin.il'i <br />❑Yes <br />❑ <br />No' <br />Has an Input wiring been inspected for proper entry and termination, including testing for ground taulfs? <br />J Yes <br />❑ <br />No` <br />, Were all tank gauging probas visually Inspected for damage and residue buildup? <br />❑ Yes <br />❑ <br />No' <br />Was accuracy of system product levet readings tested? <br />Yes <br />❑ <br />tie` <br />Was accuracy of system water level readings tested? <br />❑ Yes <br />❑ <br />No' <br />Were all probes reinstalled property? t r <br />❑ Yes <br />0 <br />NO, <br />Were ail terns on the equipment manufacturer's maintenance cherkhsi completed? <br />... ...o w...«. , , V awn,w ,.vw a„V wlnil ii�p VpI1GgIIGIC.9 AaB Or "I OR LOreCOBa. <br />G. Line Leak Detectors JLLD): ❑ Check this box if LLDs are not installed <br />complete the <br />Wowing checklist <br />X <br />Yea <br />c <br />No' <br />For equipment start-up or annual equipment cue Wt,,bon, was a leak simulated to verify LLD Performance? (Check ad <br />11 <br />MA <br />that apply) Simulated leak rate: X 3 g.p.h.; 0 0.1 g.p.h ; ❑ 02 g.p.h. <br />x <br />Yes <br />c <br />No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />X <br />Yes <br />C <br />No- <br />Was the testing apparatus properly calibrated? <br />X <br />Yes <br />7 <br />No' <br />For mechanical LLDa, does the LLD restrid product flaw if it detects a leak? <br />❑ <br />NIA <br />❑ <br />Yes <br />C <br />No' <br />For electronic LLDs, does the turbine automatically shut off If the LLD detects a leak? <br />X <br />WA <br />Yes <br />❑ <br />No' <br />For electronic LLD , does the turbine automatically shut off 'if any cotton of the monitoring systam is disabletl or <br />X <br />N!A <br />disconnected? <br />Yes <br />0 <br />No' <br />Foreieatrooio LLDs, does the turbine auWft9dCally Shut of if arty pOnion of the monitoring system malfunctions fails <br />X <br />NIA <br />or <br />a test? <br />7 <br />Yes <br />] <br />No" <br />For ektdrontc LLDs, have all accessible wiring connections been visually inspected? <br />x <br />wa <br />X Yes <br />❑ No' <br />Were all items an the equipment manufacturers marlenance checklist corrpleted? <br />H. Comments: <br />Vordtodrp System Certification Page 3 of 4 12107 <br />3 <br />2015 <br />(ENTAL <br />]TAACkIT <br />g d dt77 1091 LZAeW <br />