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I 1 0 0 <br />Monitoring System Certification - Page 3 of 3 viEGEIVED <br />Site Address: 3725 N. Tracy Blvd. FEB *e9pJAsting/Servicing, 1/29116 <br />F. In - Tank Gauging / SIR Equipment: N Chec I only for inventory control. <br />0 Check thi "box Yno Waga Vlor SIR equipment is installed. <br />This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. <br />.Com let the foliowin checklist: and termination. including testing for ground faults? <br />-02 d for proper entry <br />7i s [3 o* Has all input wiring been inspected <br />a residue <br />ue <br />ted for damage nd r d buildup? <br />C) Yes 0 No* Were all tank gauging probes visually inspected for and residue <br />s es ? <br />o Yes 0 No" Was accuracy of system product level readings tested? <br />D Yes 0 No* Was accuracy of system water level readings tested'? <br />0 Yes 0 No* Were all probes reinstalled property? <br />0* <br />0 Yes 1 0 N Were all items on the equipment manufacturer's maintenance checklist completed? <br />AI 1'. '—petpd. <br />* In Section Ii. below, aescriDe now Hnu wilrit "Ma. <br />G. Line Leak Detectors (LLD): 0 Check this box if LLD's are not installed. <br />Complete <br />the.. followin <br />lo* <br />checklist: <br />For start-up or annual equipment certification was a leak simulated to verify LLD performance? <br />Yes <br />is Yes <br />o <br />o N/A <br />equipment <br />(Check all that apply) Simulated leak rate: 0 3 g.p.h. (E); 0 0.1 g,p.h. (1), 0 0.2 g.p.h. (1). <br />Notes: 1. Required for equipment start-up certification and annual certification. <br />2, Unless mandated by local for electronic LLD start -u . <br />F!7 <br />w Yes <br />0 No* <br />Were all LLD's late within regulatory requiremen ts? <br />0 Yes <br />C, <br />0 No* <br />Was the testing apparatus , roperly calibrated? <br />For mechanical LLD's, does the LLD restrict product flow if it detects a leak? <br />D Yes <br />0 No* <br />m Yes <br />M N/A <br />0 No* <br />For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak? <br />N/A <br />LLD's, does the turbine automatically shut off if any portion o f the monitoring system is disabled <br />For - ' <br />it Yes <br />D No* <br />electronic <br />E3 N/A <br />c_ 9 <br />or disconnected? <br />I <br />For LLD's, does the turbine automatically shut off if any portion of the monitoring system <br />Ru0 <br />0 Yes <br />0 No* <br />electronic <br />0 N/A <br />malfunctions or fails q test? <br />0 0 a <br />s <br />all accessible wiring connections been visually inspected? <br />11 access <br />LLD e a accessible <br />S, have <br />i LL 's, have <br />V <br />W Yes <br />0 <br />0 0* <br />I ctro <br />F e c <br />For electronic <br />or <br />a N/A <br />s Yes <br />13 No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In Section H below, describe how and when ttiese (jenciencies were up wi <br />H. Comments: <br />