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08/22/2012 11:43AM FAX 2093330318 KSM CORP 0005/0008 <br /> F. In-Tank G ing/Sttt twQuipment: ® Check this box if tank gauging is used only for Owentixy cvntrall, <br /> Q Clerk this box if no tank gauging or SIR equi is installed <br /> This section must be tompietod N in-Wk gauging equipment is used to perform leek detedon morikonng, <br /> Complete the following checklist: <br /> IM Yes ❑ No" Has all input wiring been inapeoted for proper entry and tefmination,Including testing rat ground faults? <br /> Yes 0 No" Were all lank gauging proboxvisuafty ins nor damage and rosiduo buildup? <br /> 13 Yes 13 No• Was atxuracgr of system product level readings bested? <br /> ® Yes ® No" Was arearacy of system water level reO&O tested? <br /> Yes ❑ No. Wan all probes felmstalled properly? <br /> Yea ❑ No" were an itemes an the equipment manufacturers maintenance chwAlst completed? <br /> In Secfion M.bellow,dGeWbo how and when these denclerwes were or will be caffeCtod. <br /> Uro Look Dat (LLD): ❑ Check this box if LLD$are not installed. <br /> Com letee the fdtlquri shoCkilat: <br /> ® Yes 0 No' For equipment star-up or annual equipment cartiecation,was a Mak simulated to verity LLR pe ; once? {Check aH that appal <br /> ❑ WA Simulated leak rate; ®3 g,p.h.; ❑0.1 Q.p.h: ❑0.2 g.p.h. <br /> ❑ Yes ® No' Were all LLDs confirmed operational and socurate within regulatory requirements? <br /> ® Yes ❑ No' Was the testing apparatus properly callwated? <br /> ❑ Yes ❑ No* For meoWnical LLt?a,dues the LLD restrict product haw it a detects a leak? <br /> ® WA <br /> ❑ Yes ® Ne For oloctronto LLD*,does the turbine automatically shut orr It the LLD deter a tock? <br /> ❑ N/A <br /> ® Yea ® W For electromk:LLDs,does the turbine automatically shut off N any portion of the moniWA9 system is didtAbied of diwannoctgd? <br /> © N/A <br /> ❑ Yes ® NO- For electronic LLDs,does the turbine Automatically shut off N any portkm of Ow monitoring system malfunctions or fans a teat? <br /> ❑ NlA <br /> ❑ Yes 1D No- Fore fe LLDs,have all WoMible wiring oonnections been visually Inspected? <br /> ❑ N/A <br /> ❑ Yea ® No` Were all items on the equipment manufacturer's maimmrarue chacmist completed? <br /> "In Seottn N,below,describe how and when these deficiencies were of will be correetad. <br /> H. Comm&nte. <br /> Monkerting System Cortlflcatlon Raga 3 of 4 121/07 <br />