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a6ETTLER-RYAN INC. 0 <br />0 GR r •20-641921 <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: 'R F <br />r Yes ❑ o Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />IZ <br />Yes <br />❑ <br />No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />GGT i 8 2A <br />ff <br />Yes <br />❑ <br />No* <br />Was accuracy of system products level readings tested? <br />g <br />Yes <br />❑ <br />No* <br />Was accuracy of system water level readings tested? <br />E <br />ff <br />Yes <br />Yes <br />❑ <br />® <br />No* <br />No' <br />Were all probes reinstalled properly? <br />ENV! RONAArENT-A 1— <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />, In <br />the section H. below_ describe how and when t ese defir_ienc es were or will he rarrac_ted_ <br />G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. <br />Comnlete the followina cherldisi <br />r <br />es <br />❑ <br />o <br />or equipmen s -up or annus equipmen ce ca ion, was a leak simulated o verity LLD pe rmance c ec a <br />❑ <br />N/A <br />that apply) Simulated leak rate: ® 3 g.p.h. ❑ 0.1 g.p.h. ❑ 0.2 g.p.h. <br />Cy <br />Yes <br />❑ <br />No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />Ij <br />Yes <br />❑ <br />No* <br />Was the testing apparatus property calibrated? <br />❑ <br />Yes <br />❑ <br />No* <br />For Mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />[Z <br />N/A <br />G <br />Yes <br />❑ <br />No` <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />❑ <br />N/A <br />a <br />Yes <br />❑ <br />No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or <br />❑ <br />N/A <br />Disconnected? <br />rA <br />Yes <br />❑ <br />No- <br />For electronic LLDs, does the turbine automatically shirt off if any portion of the monitoring system malfunctions or <br />❑ <br />NIA <br />fails a test? <br />rz <br />Yes <br />❑ <br />No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />® <br />N/A <br />Ia <br />Yes <br />1 ❑ <br />No* <br />were all items on the equipment manufacturer's maintenance checklist completed? <br />— — laGuvn ns ucwwj uwaunuv IOUw a(lu wIlwll ulv w UCUulawouiwa wwfv Uf Will Uv UUFFwl . <br />G. Comments: <br />MonRoring System Certification Page 3 of 4 12/07 <br />K <br />