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Monitoring System r�Cert i cat .ti Site Address: oc e,C�� Date of Testing/Servicing: 6,Z F. In-Tank Gauging/SIR Equipment'• heck this box if tank gauging is used only for inventory control. ❑ Check this box if no tank gauging or SIF,equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: L] Yes C3No" Has all input wirluding testing for ground faults? ing been inspected for proper entry and termination, inc ❑ 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? { O Yes ❑ No* Were all probes reinstalled properly? ❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H,below,describe how and when these deficiencies Here or will be corrected. G. Line Leak Detectors (LLD): ❑ Cltecl: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.4%f3 g.p.h.; ❑ 0.1 g.p.h.2; ❑ 0.2 g.p.h.= Notes: 1. Required for equipment start-up certification and annual certification. 2. Unless mandated by local agency,certification required only for electronic LLD start-up. GZ No* Were all LLDs confirmed operational and accurate within regulatory requirerrients? Yes ❑ NO* Was the testing appa-atus properly calibrated?. G�Yes O No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? ❑ N/A ❑ Yes Ll No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a[eal.? HOYNIA ❑ No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled NIA or disconnected? ❑ Yes ❑ No* For electronic LLDs, docs the turbine automatically shut oft if any portion of the monitoring system ! N/A malfunctions 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 the Section H,below, describe how and when these deficiencies were or will be corrected. H. Comments: '] gra 1J U va�s'ri Q A cQ L 3—/v _77d ... �•nom