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RECEIVED <br /> ® Check this box if tank gauging is used only for inventoryJAN $ 1 2015 <br /> F. In-Tank Gauging I SIR Equipment: [ICheck 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. ENVIRONMENTAL <br /> Complete the following checklist: N�Q"N flCt70G?9A�D1T <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 reatlings testetl? <br /> ® Yes ❑ No' Was accuracy of system water level readings tested? <br /> ® Yes ❑ No' Were all probes reinstalled property? <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 /> Line Leak Detectors(LLD): ❑ Check this box If LLDs are not installed. <br /> Com lete the followin checklist: <br /> ® Yes ❑ No' For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performEah.e that apply) <br /> ❑ N/A Simulated leak rate: ®3 g.p.h.', ❑0.1 g.p.h; ❑0.2 g.p.h. <br /> ® Yes ❑ No' Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> ® Vas ❑ No' Was the testing apparatus property calibrated? <br /> ® Yes ❑ No' For mechanical LLDs,does the LLD restrict product flow d it detects a leak? <br /> ❑ N/A <br /> ❑ Yes ❑ No' For electronic LLDs,does the turbine automatically shut off ff the LLD tletacts a leak? <br /> ® N/A <br /> ❑ Vee ❑ No' For electronic LLDs,does the turbine automatically shut off If any portion of the monitoring system is disabed?® N/A❑ Yes ❑ No' For electronic LLDs,does the turbine automatically shut off if any portion ofthe monilonng system maMunst? <br /> ® N/A <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 Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> Monitoring System Certification Page 3 of 4 2/21/07 <br />