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9255517888 Line 1:38:51 09-24-2013 4,12 <br /> ®GE7ru)?-RYAN &C. • GR Job# 20-592178 <br /> F. In-Tank Gauging/SIR Equipment: E Check this box If tank gauging is used only for lnventdfyL�14 2013 <br /> ❑ Check this box If no tank gauging or SIR equipment is <br /> innsttalletd..'I�I! pk y /t <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. ENVIRONMENTAL <br /> !".2,r:LTiiDE!P.,,r iMENT <br /> Complete the following checklist: <br /> ❑ es ❑ o Has all input wiring been Inspected for proper entry and tentenstion,including testing for ground faults? <br /> ❑ Yes ❑ No• Were all tank gauging probes visually inspected for damage and residue bulldup? <br /> ❑ Yes ❑ No' Was accuracy of system products level raadings tested? <br /> ❑ Yes ❑ NO' Was accuracy of system water level readings tested? <br /> ❑ Yes ❑ No' Were all probes reinstalled property? <br /> ❑ Yes ❑ No' Were all items on the equipment manufacturer's maintenance checklist completed? <br /> n the Section H,below,describe how and when these deficiencies were or wl 11 be corrected. <br /> G. Line Leak Detectors(LLD): ❑ Check this box ff LLDs are not installed. <br /> Complete the following checklist: <br /> la es ❑ o For equipment start-up or annual equipment cenicahon,was a leak simulated to verify LLD performance?(check all <br /> ❑ N/A that apply)Simulated leak rate: ® 3g.p.h. ❑ 0.1 g.p.h. ❑ 0.2g.p.h. <br /> In Yes ❑ No' Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> E Yes ❑ No' Was the testing apparatus property calibrated? <br /> ❑ Yes ❑ NO' For Mechanical LLDs,does the LLD restrict product now if It detects a leak? <br /> rX WA <br /> Yes ❑ No' For electronic LLDs,does the turbine automatically shut oft it the LLD detects a leak? <br /> ❑ N/A <br /> E as ❑ Nor For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or <br /> ❑ WA Disconnected? <br /> R Yes ❑ No- For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or <br /> ❑ N/A fells a test? <br /> E Yes ❑ No. <br /> or electronic LLDs,have all accessible wiring connections been visually,Inspected7 <br /> ❑ NIA <br /> E Yes ❑ No* livere all items W the equipment manufacturers maintenance checklist Completed? <br /> In the Section H,beiow,describe how and when mese deficiencies were or will be corrected. <br /> G. Comments: <br /> Monitoring System Certification Page 3 of 4 12/07 <br /> 3 <br />