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Monitoring System Certification • F. In-Tank Gauging/SIR Equipment: M Check this box if tank gauging is used only for inventory control. ❑ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: ® Yes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ® Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? ® Yes ❑ No* Was accuracy of system product level readings tested? ® Yes ❑ No* Was accuracy of system water level readings tested? APR 2 0- 2015 ® Yes ❑ No* Were all probes reinstalled properly? ® Yes I ❑ No* I Were all items on the equipment manufacturer's maintenance checklist completed? ENVIRONMENT L * In Section H, below,describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. Complete the following checklist: ® Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? ❑ N/A (Check all that apply) Simulated leak rate: E 3 g.p.h.; ❑ 0.1 g.p.h; ❑ 0.2 g.p.h. ® Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? ® Yes ❑ No* Was the testing apparatus properly calibrated? ® Yes ❑ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ® N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled ® N/A or disconnected? ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions ® N/A or fails a test? ❑ Yes ❑ No* For electronic LLDs,have all accessible wiring connections been visually inspected? ® N/A ® Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In Section H, below,describe how and when these deficiencies were or will be corrected. H. Comments: "ALL PIPING RUN LOCATIONS SHOWN ON THE SITE DIAGRAM ARE BASED ON DIRECTION OF PIPING FROM SUMPS ARE APPROXIMATE ONLY. DIAGRAM NOT DRAWN TO SCALE." Page 3 of 4 till-1136- www.uiiidocs.org Rev.01/17/08