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NOV-13-2013 15:13 From: 2098254549 To:4693433 page:15�19 <br /> F. In.Tank Gauging f Sift equipmgnb ® Check this box if tank gauging is used only for III Rx E I VE D <br /> ❑ Check this box Ono tank gauging or SIR equipment is in,. <br /> This teCWr must be completed If In-tank gauging equipment:4 Uaed to perform leak detection monitoring, NOVw Complete the followingchacktist: V 1. 2 2013 <br /> ❑ Yes ❑ No' Has alilnputwiring been inspected for proper entry and tennmabon,including testing for ground faults? ENTAL <br /> ❑ Yea ❑ No' Were all tank gauging probes visually inspected for damage and residue buildup? H T TMENT <br /> ❑ Yes ❑ No' Was accuracy of system product level readings tested? <br /> ❑ Yes ❑ No" Was accuracy of system water level readings tested? <br /> ❑ Yes ❑ Na' Were all probes reinetanep properly? <br /> ❑ Yea ❑ No• Were all items an the equipment manufacturer,maimenance Checklist completed? <br /> 'In Section M,baits,describe how,and when these deflcienties were a will be corrected. <br /> Line leak Detectors(LLA): ❑ Check this box I LLD,are not installed. <br /> Comolete the faflowinat checklist: <br /> ® Ye6 ❑ No• For equipment elan-up or annual equipment certification, wet a leak simulated to verity LLD performance? (Cneck an that 'dopy) <br /> ❑ N/A Simulated leak rate: 143 g,p,h.; ❑0.t g.p.h ❑02 g,p,h. <br /> 19 Yes ❑ No• Were all LLDs confirmed operational and accurate within raguNrtory,requirements? <br /> 51 Yes 0 Np' Was the testing apparatus property calibrated? <br /> q Yes ❑ Nur For mechanical LLDS,doss the LLA restrict product flaw Of it detects a leak? <br /> ® INA <br /> ❑ Yes ❑ No' For elecbonk LLDa,does the turbine automatically shut off if the LLD oatecLe a leak? <br /> ® N/A <br /> ❑ Yes ❑ No' For electronic LLD&does the turbine auiomabcauy stat off if any portion of the monAwng system a disabled or dleconnected? <br /> 14 WA <br /> ❑ Yes ❑ Ne Far electronic ll does the turbine automatically shut off d any portion of the monfering System malfunctions or fail,a Iset? <br /> 14 N/A <br /> ❑ Yes ❑ Ne" For electronic LLDshave all accessible wiring connections been visually inspecled? <br /> N/A <br /> gg Yes ❑ No' Were all Items on the equipment manufacturers maintenance checklist completed? <br /> o—•tlion N,blow,describe how and when these deficiencies ware er will be g.rrnni ed. <br /> M. Comments: <br /> 87 100 2 18 22 <br /> 87 2 120 3 28 21 - - - <br /> DSL 120 4 23 21 <br /> gnit ring system Certification Page 3 of 4 2i21M <br /> Monitoring System Certification <br />