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F. In -Tank Gauging I SIR Equipment: ® Check this box if tank gauging j used only for inventor, L <br />❑ Check this box if no tank gauging or SIR equipment is Irbrit. 11 2013 <br />This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. <br />Complete the following checklist: ENVIRONMENTAL <br />HEALTH DERAEUM <br />NT <br />® <br />Yes <br />❑ <br />No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />® <br />Yes <br />❑ <br />No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />® <br />Yes <br />❑ <br />No* <br />Was accuracy of system product level readings tested? <br />® <br />Yes <br />❑ <br />No* <br />Was accuracy of system water level readings tested? <br />® <br />nYesYes <br />1:1No* <br />No* <br />Were all probes reinstalled properly? <br />❑ <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 />.ine Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. <br />rn .I.tn nc. M11—inn rhnr41ic4• <br />® <br />Yes <br />❑ <br />No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) <br />❑ <br />N/A <br />Simulated leak rate: ® 3 g.p.h_ ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. <br />® <br />Yes <br />❑ <br />No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />® <br />Yes <br />❑ <br />No* <br />Was the testing apparatus properly calibrated? <br />® <br />Yes <br />❑ <br />No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ <br />N/A <br />❑ <br />Yes <br />❑ <br />No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />® <br />N/A <br />❑ <br />Yes <br />❑ <br />No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br />® <br />N/A <br />❑ <br />Yes <br />❑ <br />No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br />® <br />N/A <br />❑ <br />Yes <br />❑ <br />No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />® <br />N/A <br />® <br />Yes <br />❑ <br />No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />In Sea,ion H, below, describe how and when these deficiencies were or will be corrected. <br />H. : omments: <br />Monitoring System Certification Page 3 of 4 2/21/07 <br />