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Monitoring System Certification <br /> F, In-Tank Gauging/SIR Equipment: Check.this box if tank gauging is used only for inventory control. <br /> ❑ Check this box if no tank gauging or SIR oquipmcnt 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 Q 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 /> Q Yes ❑ No* Was accuracy of system product level readings tested? <br /> 0 Yes ❑ No* Was accuracy of system water level readings tested? <br /> ❑ Yes p No* Were all probes reinstalled properly? <br /> ❑ Yes ❑ No* Were all items on the equipment manufacturor's maintenance checklist completed? <br /> * in Section H,below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leah;Detectors (LLD): ❑ Check this box if LLDs are not installed. <br /> Com lute the foliowin checklist: <br /> Yes ❑ No* For equipment start-up or annual equipment crtification, was a leak simulated to verify LLD performance? <br /> ❑ NIA (Check all thar apply) Simulated icak rate: g.p,h.; ❑0.1 g,p.h; C7 0.2 g.p.h. <br /> Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> 1 Yes ❑ No* Was the testing apparatus properly calibrated? <br /> os © 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 /> 16 NIA <br /> Q Yes (] No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> NIA or disconnected? <br /> 0 Yes ❑ No* For electronic LLDs,docs the turbine automatically shut off if any portion of the monitoring system malfunctions <br /> A NIA or fails a test? <br /> p Yes ❑ No* For electronic LLDs,have all accessible wiring connoctions been visually inspected? <br /> NIA <br /> Yes ❑ No" Were all items on the equipment manufacturer's maintoTmuc Checklist completed? <br /> In Section H,below,describe how and when these deficiencies were or will be corrected. !! <br /> H. Comments: f <br /> HU ' LIVE71, <br /> MAR 2 4 2014 <br /> DEPARTMENT <br /> Page 3 of 4 <br /> UN-036-5/6 www.uutdocs.orE Rev.OV17M <br /> S:S'd 22b209t7:01 96,L ZISS602 39NdI-1dWO3 1S0:WOJd t,2:60 bi02-22-JdkJ <br />