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Monitoring System Certification <br /> F. In-Tank Gauging/ SIR Equipment: ❑ Check this box if tank gauging is used'unly for inventory control. <br /> ❑ Check this box if no tank gauging or SIR equipment is installed. <br /> ' 6. 2013 <br /> Thus section must be completed if in-tank gauging egtupment is used to perform leak, detection mofo.�i oring. <br /> Complete the following checklist: � ��H � TAL <br /> HEALTH DE=" �:TMENT <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 0 No* Was accuracy of system product level readings tested? <br /> * Yes ❑ No* Was accuracy of system water level readings tested? <br /> * Yes ❑ NO Were all probes reinstalled properly? <br /> ® Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> �'In Section II,below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors (LLD): [j Check this box i.f LLDs are not installed. <br /> Complete the follo ing cbecklist: <br /> ® Yes ❑ No* For equipment start-up or annual equipment certification, was a leak. simulated to verify LLD performance`' <br /> ❑ N/A (Check all that apply) Simulated leak rate: ®3 g.p_h.; ❑ 0.1 g.p.h ; [10-2 o.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 /> ❑ NIA <br /> * Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> ❑ N/A, or disconnected? <br /> ® Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions <br /> ❑ N/A or fails a test? <br /> ® 'Yes ❑ No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> ❑ N/A <br /> 0 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: <br /> Page 3 of 4 <br /> UN-036—5/6 www.noidoc.5.org Rev.01/19/08 <br />