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Morriloring System Certification RECEIVEP <br />F. Ing -Tank Gauging / STS! >E quipmeat: �I Check this box i.f tank gauging is used ojkWr'. enlffi�!,cunl'rol. <br />❑ Check this box if no tank gauging or Slll equi int if irfstalled. <br />This section must be completed if in -tank gauging equipment is used to perform <br />HEAMI0 FA ,,AAS:NT <br />Complete the following checklist: <br />0 Yes <br />CI No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />❑ Yes <br />C5 No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />❑ Yes <br />❑ No* <br />Was accuracy of system product level readings tested? <br />❑ Yes <br />❑ No* <br />Was accuracy of system water level readings tested? <br />❑ Yes <br />p No* <br />Were all probes reinstalled properly? <br />C� Yas <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />ua vas %PA4 ..., uc►vn, ucx..vc 114,Pw auu wuru Lure¢ ueucieucies were or win ve corrected. <br />G. Line Leak Detectors (LLD): ❑ Check this box if 1,LDs are not installed, <br />Yes ❑ No* For equipment start-up or annual equipment; certification, was a ICA simulated to verify LLD performance? <br />0 N/A (Check all that app/y) Simulated leak.rate: 16 g.p,h.; ❑ 0.1 g,p,h ; ❑ 0.2 g.p.h, <br />Yes Q No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br />Yes 0 No* ` Was the testing apparatus properly calibrated? <br />11 Yes Q No* For tnechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ N/A <br />l Yes C No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />lN/A❑ Yes © No* For electronic LLDs, does the turhine automatically shut off if any portion of the monitoring system is disabled <br />N/A or disconnected? <br />❑ Yes 0 No* For electronic LLDs, does the turbine aut <br />16 N/A I or fails a tesfl omatically shut off if any portion of the monitoring system malfunctions <br />❑ Yes No* For electronic LLDs, have all accessible wiring connections been visually inspected7 <br />N/A <br />YCa ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br />" In Section H, below, describe how and when these deliclenelesi were or will be corrected. <br />H. Comments: I <br />UN -036 5/6 <br />Page 3 of 4 <br />www.uoldumorR <br />Rcv. 01/17/ItA <br />S��'d M7299t7:01 96-TTES602 90NUI-ldW00 1Sn_W0ad 9S: _J0 t7T©2-t,2-AHH1 <br />