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r, <br /> F. In-Tank auging/SIR Equipment: ® Check 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 must 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 [I No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ® Yes IP 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 manufacture s maintenance checklist completed? <br /> In Section H,below,describe how and when these deficiencies were or will be corrected. <br /> Line Leak Detectors(LLD): ❑ Check this box if LLDs are not installed. <br /> Com Tete the followinI checklist: <br /> ® Yes ❑ No` For Smulatepme equipment <br /> rstert®3r annual Out 9 P h;c❑IO certification, a leak simulated to verify LLD performance? (Check all that apply) <br /> ❑ N/A <br /> ® Yes ❑ No` Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> ® Yes ❑ No' Was the testing apparatus properly calibrated? <br /> ® Yes ❑ No' For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> ❑ N/A <br /> ❑ Yes ❑ No' For electronic LLDs,does the turbine automalically shut off if the LLD detects a leak? <br /> ® N/A <br /> ❑ Yes ❑ No` For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> ® N/A <br /> ❑ Yes ❑ No` For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test. <br /> ® N/A <br /> ❑ Yes ❑ No' For electronic LLOs,have all accessible wiring connec ions been visually inspec etl? <br /> ® N/A <br /> ® Yes ❑ No' Were all items on the equipment manufacturer's maintenance checklist completed? <br /> `In Section H,b low,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> DSL 100 3 27 22 PASS <br /> Page Monitoring System Certification ge3of4 2/21/07 <br />