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Monit-ring System Certification • • <br /> Site Address: Date of Testing/Seryicing: <br /> F. In-Tank Gauging/SIR Equipment: heck 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]rust 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 /> ❑ Yes ❑ No* Were all probes reinstalled properly? <br /> ❑ 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 /> Co tete the following checklist: - <br /> Yes ❑ No* For equipment start-up or annual equipment cc tfication, was a leak simulated to verify LLD performance? - <br /> ❑ N/A (Check all that apply) Simulated leak rate: ;�3 g.p.h.; ❑ 0.1 g.p.h ; ❑02 g.p.h. <br /> es ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? _ <br /> Yes ❑ No* Was the testing apparatus properly calibrated? - <br /> Jd Yes ❑ No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? _ <br /> ❑ N/A <br /> ❑ Yes ❑ * For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br /> N/A <br /> ❑ Yes ❑jNo* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled: <br /> ,6 N/A or disconnected? <br /> ❑ yes ❑ o* 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 /> ❑ Yes ❑ o* For electronic LCDs,have all accessible wiring connections been visually inspected? <br /> C1 N/A <br /> 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 /> H. Comments: <br /> r <br />