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NOV 2 0 2014 <br /> Monitoring System Certification <br /> ENVIRONMENTAL HEALTH <br /> F. In-Tank Gauging/SSR Equipment: ® Check this box iftank gauging is useQ@rNTontrol. <br /> ❑ Check this hnx if w tank gauging or SIR equipment is installed. <br /> This section must be wmpleted if it,tank gauging equipment is used to perform teak detection monitoring. <br /> Complete the following checklist: <br /> ❑ Yes [3 No* Flan all input wiring been inspected far proper imtry and termination,including testing for ground faults? <br /> ❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ❑ Yes ❑ Not Was accuracy of system product level readings tested? <br /> ❑ Yes L] No* Was accuracy of syste.n water level readings tested? <br /> ❑ Yos El No* Were all probes minsbdled properly? <br /> ❑ Yes ❑ No" Were all items on the equipment:manufacturer's maintenance checklist completed? <br /> *In the Section N,below,describe how aid when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors(LLD): ❑ Check this box if LLDs are not installed. <br /> Cam tete the rollowiu checklist: <br /> H Yes ❑ Nov For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br /> ❑ N/A (Check all that apply) Simulated leak rate: 0 3 g.ph; ❑0.1 g.p.h; ❑0.2 g.p.li. <br /> ® Yes ❑ No• Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> ® Yes ❑ No° Was the testing appamw properly calibrated? <br /> ® Yes ❑ NO For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> ❑ NIA <br /> p Yes ❑ Nov For electronic LLDs, foes 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 if any portion of rhe monitoring system is disabled <br /> 0 NIA or disconnected? <br /> ❑ Yes ❑ Nov For electronic LLDr, does the turbine automatically shut off if any portion of the munkoring system <br /> ® NIA malfunctions or fails A test? <br /> ❑ Yes O No' For electronic UDs, 'cave all accessible wiring connections been visually inspected? <br /> ® NIA <br /> CK Yes ❑ No" Were all items on the equipment manufacturer's maintenance checklist completed? <br /> •In the Section H,blow,describe how rind when these deficiencies were or will be corrected. <br /> H. Comments: <br /> P2RP 't of a <br /> I <br /> V £9699V960Z wnelaled elgeilea e4£'1704L OZ AoN <br />