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E <br />Monitoring System Certification - Page 3 of 3 <br />Site Address: 2701 March Ln. <br />REGE 0 <br />IVED <br />MAY 18 2015 <br />Date of Testing/Servicing: 4123/15 <br />-1MVINUNI ENTAL <br />F. In -"lank Gauging / SIR Equipment: 0 CheTffliTbVjxq%1FATMW,- <br />, is used only for inventory control. <br />13 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 />Camnlptp the fhUnwina ehoetri-t- <br />o Yes <br />0 No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />11 Yes <br />0 No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />0 Yes <br />0 No* <br />Was accuracy of system product level readings tested? <br />0 Yes <br />0 No* <br />Was accuracy of system water level readings tested? <br />0 Yes <br />a No* <br />Were all probes reinstalled properly? <br />0 Yes <br />0 No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />.• in o-ection H Delow, aescrine now and when these deficiencies were or will be corrected. <br />G. Line Leak Detectors (LLD): Check this box if LLD's are not installed. <br />Comnlete the, falinwina rhi-ekli4a- <br />0 Yes <br />0 NTo* <br />For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? <br />0 N/A <br />(Check all that apply) Simulated leak rate: 0 3 g.p.h, (l.); 0 0.1 g.p.h. (2.); 0 0.2 g.p.h. (1). <br />Notes: 1. Required for equipment start-up certification and annual certification. <br />1 Unless mandated by local Hency, certification required only for electronic LLD start-up. <br />a Yes <br />0 No* <br />Were all LLD's confirmed ocrational and accurate within regulatory requirements? <br />0 Yes <br />13 No* <br />Was the testing apparatus properIL calibrated? <br />0 Yes <br />0 No* <br />For mechanical LLD's, does the LLD restrict product flow if it detects a leak? <br />0 N/A <br />0 Yes <br />0 No* <br />For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak? <br />o N/A <br />0 Yes <br />(I No* <br />For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />0 N/A <br />or disconnected? <br />0 Yes <br />0 No* <br />For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system <br />0 N/A <br />malfunctions or fails a test? <br />0 Yes <br />13 No* <br />For electronic LLD's, have all accessible wiring connections been visually inspected? <br />0 N/A <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />- ----- ----- _ <br />* In Section H below, describe how and when these deficiencies were or will be corrected. <br />H. Comments: Not required to be tested. <br />