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F. In -Tank Gauging SIR Equipment: •X Check this box it tank gauging is used only for inventory cors <br />❑ Check this box if no tank gauging or SIR equipment is installed <br />This section must be completed din -tank gauging equipment is used to perform leak detection monitoring. <br />Complete the following checklist: <br />❑ Yes <br />❑ No- <br />Has all input Wang been inspected forproper entry and termination, incuding testing for ground faults? <br />❑ Yes <br />❑ No' <br />Were all lank gauging Probes visually inspected for damage and residue buildup? <br />❑ Yea <br />❑ No' <br />Was accuracy 0 system product level h ading$ tested? <br />❑ Yes <br />❑ No' <br />Was accuracy of system water level readings tested? <br />❑ Yes <br />❑ No' <br />Were all probes reinstalled properly? <br />❑ Yes <br />❑ No' <br />Were all items on me equipment manufacturers maintenance checklist completed? <br />In Section H, below, describe how and when these deficiencies were or will be connected, <br />fine Leak Detectors (LLD): ❑ Check this box if LLDs are not installed <br />r'.—lrla uh, frill eMeYllir' <br />X Yes <br />❑ No' <br />For equipment stat or annual equipment ceNfication, was a leak simulated to verify LLD performance? (Check all that apply) <br />❑ N/A <br />Simulated leak all X3 g.p.h.; 110.1 g.p.h; 110.2 g.p.h. <br />X Yes <br />❑ NW <br />Were all LLD. confirmed operational and accurate within regulatory requirements? <br />X Yes <br />❑ Na' <br />Was the testing apparatus properly caliburted? <br />X Yes <br />❑ No' <br />For mechanical LLDs, does the LLD restrict product flow H It detects a leak? <br />❑ N/A <br />❑ Yes <br />❑ No' <br />For electronic LLDs, does Me turbine automatically shut oN if Ne LLD detects a leek? <br />X WA <br />❑ Yes <br />❑ No' <br />For electronic ILD., does the turbine automatically shut off g any portion of the monitoring system is disabled or disconnected? <br />X WA <br />❑ Yes <br />❑ No' <br />For electronic LLDs, does the turbine automatically shut off 0 any potion of the monitoring system malfunctions or fails a test? <br />X WA <br />❑ Yes <br />❑ No- <br />For electronic LLDs, have all accessible wining connections been visually inspected? <br />X WA <br />X Yes <br />1 ❑ No' <br />I Were all items on me equipment manufacturers maintenance checklist completed? <br />In Section H, below, describe haw and when these deficiencies were or will be corrected. <br />H. Comments: <br />Monitoring System Certification page 3 of 4 2/21/07 <br />