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rLE - GR Job 17203105 <br /> t1Er R RYAN INt. <br /> F. In-Tank Gauging/SIR Equipment: ❑ Check this box if tank gauging is used only for inventory control. <br /> ❑ 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 /> Complete the following checklist: <br /> G Yes 1 ❑ o Has all input wiring been inspected for proper entry and termination,including testing for ground fa <br /> ffYes [3No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> r% loom e% lm`i�iF- <br /> Ez Yes ❑ No* Was accuracy of system products level readings tested? <br /> EL- Yes ❑ No* Was accuracy of system water level readings tested? <br /> [j Yes ❑ No* Were all probes reinstalled properly? <br /> 11 Yes 1 ❑ No' lWere all items on the equipment manufacturer's maintenance checklist completed? <br /> n the 3ection H,-b-eFo-W--,de-9—cWhow ana when these deficiencies were or will be corrected. HEA <br /> G. Line Leak Detectors(LLD): ❑ Check this box if LLDs are not installed. DERART ENT <br /> Complete the following checklist: <br /> Ii Yes ® o or equrpme s up or annual equipment certification,was a leak simulatecl to venry LLD pe nuance all <br /> ❑ N/A that app(y)Simulated leak rate: ❑ 3 g.p.h. ❑ DA g.p.h. ❑ 0.2 g.p.h. <br /> ra Yes ❑ No' Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> lis Yes ❑ No` Was the testing apparatus property calibrated? <br /> EI Yes ❑ No` For Mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> E-L N/A <br /> [Z Yes ❑ No" For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ❑ N/A <br /> [i Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or <br /> ❑ N/A Disconnected? <br /> [Z Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if any porton of the monitoring system malfunctions or <br /> ❑ N/A fails a test? <br /> Ei 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 ectlon H,below,describe how and when these deficiencies were or will be corrected. <br /> G. Comments: <br /> Monitoring System Certification Page 3 of 4 112107 <br /> 3 <br />