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Mar, 26. 2013 10 : 36AM Qo n l e e Pump Co. <br />Monitoring System Certification <br />F, In -Tank Gauging I SIR Equipment: <br />No, 2172 F, 4 <br />❑ Check this box if tank gauging is used only for inventory control. <br />IR Check this box if no tank gauging or S1R 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 <br />❑ No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />❑ Yes <br />❑ 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 />❑ No* <br />Were all probes reinstalled properly? <br />❑ Yes <br />* In Sectiou <br />❑ No* I Were all items on the equipment manufacturer's maintenance checklist completed? <br />H. below, describe how and when these deficiencies were or will be corrected. <br />G. Line Leak Detectors (LLD): <br />Cmmnlete the fnllnwinur oherklict! <br />❑ Check this box if LLDs are not installed. <br />W Yes <br />❑ No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />❑ N/A <br />(Check all that apply) Simulated leak rate: J, 3 g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. <br />it Yes <br />❑ No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />ML Yes <br />❑ No* <br />Was the testing apparatus properly calibrated? <br />Ig Yes <br />❑ No* <br />For mechanical LLD&, does the LLD restrict product flow if it detects a leak? <br />❑ N/A <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />IS N/A <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion. of the monitoring system is disabled <br />0 N/A <br />or disconnected? <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions <br />N/A <br />or fails a test? <br />❑ Yes <br />❑ No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />N/A <br />{� Yes <br />❑ No* <br />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 />H. Comments: At , Lii• <br />Page 3 of 4 <br />VN -036— 5/6 www.unidvcaorfi Rev. 01/17/08 <br />