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0 <br />0 <br />F. In -Tank Gauging I SIR Equipment: X 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 />Comolete the followino checklist: <br />Yes <br />_ No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />Yes <br />I ' No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />Yes <br />I No* <br />Was accuracy of system product level readings tested? <br />Yes <br />I No* <br />Was accuracy of system water level readings tested? <br />Yes <br />L; No* <br />Were all probes reinstalled properly? <br />[I Yes <br />ri No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />in the Section n, Deiow, aescnue now ana wnen mese oenciencies were or wm oe correciea. <br />G. 'Line Leak Detectors (LLD): I Check this box if LLDs are not installed. <br />rmmnlofo !ho fnllnwinn rheririisf- <br />ENVIRONMENTAL <br />H€ALTH nFRaPTA,fcnrr <br />X <br />Yes <br />I <br />No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all <br />A <br />NIA <br />thatapply) Simulated leak rate: X 3 g.p.h.; 110.1 g.p.h ; ; . 0.2 g.p.h. <br />X <br />Yes <br />I <br />No* <br />Were all LLDs. confirmed operational and accurate within regulatory requirements? <br />X <br />Yes <br />F1 <br />No* <br />Was the testing apparatus properly calibrated? <br />X <br />Yes <br />I <br />No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />-1 <br />NIA <br />i <br />Yes <br />No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />X <br />NIA <br />Yes <br />_ <br />No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or <br />X <br />NIA <br />disconnected? <br />Yes <br />No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails <br />X <br />NIA <br />a test? <br />Yes <br />r <br />No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />X <br />NIA <br />X <br />Yes <br />I- <br />No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />m the section n, below, aescrioe now ana wnen tnese aeticiencies were or wui De correciea. <br />H. Comments: <br />Monitoring System Certification Page 3 of 4 12107 <br />3 <br />2/21/07 <br />