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UNDERGROUI :TORAGE TANK MONITORING SYSTlt -'ERTMCATION <br /> F. In-Tank Gauging/SIR Equipment: Permit Number. <br /> El Check this box if tank eauginz is used only far ' entory control <br /> ❑ Check this box if no tank gauging or S equipment is installed <br /> This section must be completed if in-tank g ging equipment is used to perform leak detection monitoring. <br /> Com Iete the foliowingo checklist: <br /> ❑ Yes I ❑ No* Has all input wiring been uApected for proper entry and termination, including testing for ground faults? <br /> ❑ Yes ❑ No* Were all tank Muging pro es visually inspected for damage and residue buildup? <br /> ❑ Yes ❑ No* Was accuracy of system pr duct level readings tested? <br /> ❑ Yes ❑ No* Was accuracy of system watk level readings tested? <br /> ❑ Yes ❑ No* Were all probes reinstalled pro rly? <br /> ❑ Yes 1 ❑ No* Were all items on the equipment ufacturer's maintenance checklist completed? <br /> In Section H below,describe how and when these deft 'encies were or will be corrected. <br /> G. Line Leak Detectors (LLD): ❑'Check this x if LLDs are not installed. <br /> Complete the following checklist: <br /> ❑ Yes ❑ No* For equipment start-up or annual equip nt certification, was a leak simulated to verify LLD performance? <br /> El NIA (Check all that apply) 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 ccurate within regulatory requirements? <br /> ❑ Yes ❑ No* Was the testing apparatus properly calibr ted? <br /> ❑ Yes ❑ No* For mechanical LLDs, does.the LLD re 'ct product flow if it detects a leak? <br /> ❑ N/A <br /> ❑ Yes ❑ No* For electronic LLDs, does the turbineautomatically shut off if the LLD detects a leak? <br /> ❑ N/A i <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 malfiwctions <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 /> ❑ 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 /> DEH:EM-9301,(Rev 08/02). Page 3 d4 Counn•of San Diego-DEH-Hazardous Materials Division <br />