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140721-003 <br /> F. In-Tank Gauging 1 SIR Equipment: W Check this box if tank gauging is used only for inventory control. <br /> 0 Check this box if no tank gauging or Slit 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 /> H Yes ❑ No' Has all input wiring been inspected for proper entry and Termination,including testing for ground faults? <br /> N Yes © No' Were all tank gauging probes visually inspected for damage and residue buildup? <br /> W Yes ❑ No' Was accuracy of system product level readings tested? <br /> a Yes No" Was accuracy of system water level readings tested? <br /> R Yes No" Were all probes reinstalled properly? <br /> Yes ❑ No" Were all items on the equipment manufacturer's maintenance checklist completed? <br /> In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors(LLD): io Check this box if LLDs are not installed. <br /> Complete the follow ng checklist: <br /> [] Yes ❑ No" For equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance? (Cha(*all <br /> ❑ NIA that apply) Simulated leak rate: 03 g.p.h.; 00.1 g.p.h; 00.2g.p.h. <br /> Yes No' Were all LCDs 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 /> NIA <br /> Yes No` For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> NIA <br /> ❑ Yes No' For electronic LLDs, does the turbine automatically shut off it any portion of the monitoring system is disabled or <br /> NIA disconnected? <br /> 0 Yes No" For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or <br /> NIA fails a test? <br /> © Yes No' For electronic LLDs,have ail accessible wiring connections been visually inspected? <br /> N/A <br /> Yes ® No' Were all items on the equipment manufacturer's maintenance cheddist completed? <br /> *In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> Monitoring System Certification Page 3 of 4 12107 <br /> 3 2/21107 <br />