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0 0 <br /> F. In-Tank Gauging/SIR Equipment: ® Check this box If tank gauging is used only for inventory control. <br /> ❑ Check this box g 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 ❑ No' Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ® Yes ❑ 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 manufacturer'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 ff LLDs are not installed. <br /> Complete the following checklist: <br /> ® Yes ❑ No' For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) <br /> ❑ N/A Simulated leak rate: ®3 g.p.h.; [10.1 g.p.h; ❑0.2 g.p.h. <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 automatically 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 orfails a test? <br /> ® N/A <br /> ❑ Yes ❑ No' Foreleclrome LLDs,have all accessible wiring connections been visually inspected? <br /> ® N/A <br /> ® Yes ❑ No' Were all items on the equipment manufacturer's maintenance checklist completed? <br /> 'In Section H,below,describe how and when these deficiencies were orwill be corrected. <br /> H. Comments: <br /> 87 120 3 25 13 PASS <br /> 89 130 5 27 13 PASS <br /> 91 110 5 25 16 PASS <br /> DSL 100 3 27 21 PASS <br /> MAR 252016 <br /> ENVIRONMEML <br /> HEALTH DERVNENT <br /> Monitoring System Certification Page 3 of 4 2/21/07 <br />