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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 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? s <br /> ❑ Yes ❑ No' Was accuracy of system water level readings tested? pp� d <br /> El Yes El No* Were all probes reinstalled properly? AFF � J 2tl i f <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. tZINVIKUNNALN AL HEALTH <br /> Line Leak Detectors(LLD): ❑ Check this box if LLDs are not installed. PERM IT/SER\ACES <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.; ❑0.1 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 or fails a test? <br /> ❑ N/A <br /> ® Yes ❑ No` For electronic 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 or will be corrected. <br /> H. Comments: PLLDS PASS-GOOD <br /> Monitoring System Certification Page 3 of 4 2/21/07 <br />