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Monitoring System Certification <br />ie H.rdres;a: ri970 WEST LANE <br />nate of T'estirn,!Uerv,ce: <br />F, In -Tank Gauging / SIR Equipinent <br />OF,i/r61_'�Jl_ <br />Check this box !f tank CAU( :ng i :; a,:Cl ;ruy for illbt" I.Ory cc•7,ti0r. <br />Check !tris box it no tangy:ySIR e(Ito rrnerlt <br />',Z?0iorl must be completed if in -tank gauging equipment is used to perforin leak !;ic•tsctiorro rr;orlitorirtg- <br />to the tollowinq checklist: <br />I t, j No • Has all input wiring been inspected for proper entry and terminatio(,, inciue ng te,,%nq for grc...nu l,, tits l I <br />i' es No • Were all tank gauging probes visualiy inspected for damage and residue buifdup? 1 <br />s ! NO Wi)s accuracy of system product level readings tested? l <br />C �tt, • Was accuracy of system water level readings tested? <br />�tJo • Were all probes reinstalled properly? <br />Were alt items on the equipment manufacturers' maintenance checklist cotnpletedl <br />dor iur7 H, below, describe how and when these deficiencies were or will be corrected- <br />t , . 11-itte Leak Detectors (LLD) : <br />Check this box if LLDs are nct inst:;Eled. <br />'j:-' the following checklist: <br />For equipment start-up or annual equipment certification, was a leak simulated to verity LLD performance? <br />(Check aD that apply) Simulated leak rate: [] 3 g.p.h N.h 00.2 g p,h <br />E Were all LLDs confined operational and accurate within regulatory requirements? <br />Was the testing apparatus properly calibrated? <br />s <br />LINO ' [`] N/A For mechanical LLDs, aces the LLD restrict product flow if it detects a leak? <br />'- E]N. • [J NrA For electronic LLDs, does the turbine automatically shut oft if the LLD Geteuis a leak.? <br />s _]No { N A For electronic LLDs, does the turbine automatically shut off if arty portion of the mon tui ng system s d � itdr.a r, dig,(ru r ti,l<"t <br />N/A For electronic LLDs, does the turbine_ automatically shut off if arty portion of the monitor ng syster, malfur f4: s a ;+.e t? <br />«�t _1 [INo • N!A For electronic LLDs, have all accessible wiring connections been visually inspocted? <br />A •Y :; r]N. Were all items on the equip-nent manufacturers' maintenance checklist completed? <br />t;, , Scct;on ti, below, describe how and when these deficiencies were or wirl be corrected. <br />K Comments: <br />_ page 3 Y 3 <br />11 M <br />