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6ETTLER-RYAN INc. GR Job # 20-632266 <br />F. In -Tank Gauging / SIR Equipment: jj Check this box if tank gauging is used only for inventory control. <br />a 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. RECEIVEL <br />Complete the following checklist: <br />IA- <br />Yes 1 0 <br />NO' Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />nrT fl r, <br />r,Yes <br />No* Were all tank gauging probes visually inspected for damage and residue buildup? <br />[3 <br />Ej <br />Yes [3 <br />No* Was accuracy of system products level readings tested? <br />ENVIN <br />Yes <br />E <br />Yes [3 <br />No* Was accuracy of system water level readings tested? <br />1011,090N <br />I& <br />Yes [3 <br />No* Were all probes reinstalled property? <br />U111i7k4c <br />11 <br />Yes , [3 <br />NO* Were all items on the equipment manufacturers maintenance checklist completed? <br />NO* <br />* In <br />the Section H, <br />below, describe how and wfi-en-We—se deficiencies were or will be corrected. <br />I rA <br />G. <br />Line Leak <br />Detectors (LLD): a Check this box if LLDs are not installed. <br />Yes <br />Comnlata the follnwinn rhocklist* <br />No* <br />[Z <br />Yes <br />Ej <br />Wo�"For <br />—equipment start-up or annual equipment certifica n, was a leak simulated 13 verify LLD performance? (check all <br />[3 <br />N/A <br />that apply) Simulated leak rate: [1 3 g.p.h. [3 0.1 g.p.h. [3 0.2 g.p.h. <br />Yes <br />No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />jj <br />Yes <br />No* <br />Was the testing apparatus prop;; calibrated? <br />[3 <br />Yes <br />[3 <br />NO* <br />For Mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />I rA <br />N/A <br />[j <br />Yes <br />[3 <br />No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />N/A <br />Yes <br />NO* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or <br />N/A <br />Disconnected? <br />Yes <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or <br />13 <br />NIA <br />failsa tes . <br />Yes <br />11 <br />No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />[] <br />N/A <br />ra <br />Yes <br />[3 <br />No* <br />were all items on the equipment manufacturers maintenance checklist completed? <br />IPI UTV QC UVII F"E, UMVW, UUM—LEW ff1VW G11U W-91 Ul­ U—G.W.UIMb WVVU WE W111 UV 4UIFVUmu. <br />G. Comments: <br />Monitoring System Certification Page 3 of 4 12/07 <br />9 <br />&T <br />