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, F. In-Tank Gauging/SIR Equipment: �I' {1k�]® ® Check this box if tank gauging is used only for in .1 r� 7 ❑ Check this box if no tank gauging.,SIR equipment is Installed. This section must be Completed If in-tank gauging equipment is used to perform leak detection monitoring. APR eO 1 D!1 �O�C U Complete the following checklist: A 1 ❑ Yes ❑ No' Has all input wiring been inspected for proper entry and termination,including testing for ground faults? .. .r IFS "ITr ❑ 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? ❑ Yes ❑ No' Were all probes reinstalled property? ❑ Yes ❑ No' Were all items on the equipment manufacturers maintenance checklist completed? In Section H,below,tlescribe how and when these deficiencies were or will be corrected. Line Leak Detectors(LLD): ❑ Check this box ff LLDs are not installed. Cam letethefollowin checklist: ® Yes ❑ No' For equipment start-up or annual equipment certification, was a leak simulated to verify LLD perfojordisconnected? dthat ❑ N/A Simulated leak rate: ®3 g.p.h.; ❑ ,. g.p.h; ❑g-g.pA ® Yes ❑ No' Were all LLDs confirmed operational and accurate within regulatory requirements? ® Yes ❑ No' Was the testing apparatus property 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 dis® N/A ❑ YesNo' For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfu ® N/A ❑ 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,tlescribe now and when these deficiencies were or will be comected. H. Comments: Monitoring System Certification Page 3 of 4 2/21/07