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#I <br />'Monitoring System Certification <br />F. In -Tank Gauging / SIR Equipment: <br />0 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 />0 Yes <br />0 No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />El Yes <br />0 No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />0 Yes <br />0 No* <br />Was accuracy of system product level readings tested? <br />0 Yes <br />I El No* <br />Was accuracy of system water level readings tested? <br />0 Yes <br />0 No* <br />Were all probes reinstalled properly? <br />0 Yes <br />0 No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />.. 1H 3CCUOU III MOW, aescrioe now ana wnen tnese aenciencies were or will be corrected. <br />1110 11111111pe 111111111! : 11�� 11 111� 1 11,�111 1 lip <br />Comnlete the following checklist! <br />rl Check this box if LLDs are not installed. <br />0 Yes <br />El No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />E] N/A <br />(Check all that apply) Simulated leak rate: 0 3 g.p.h.; [10. 1 g.p.h ; El 0.2 g.p.h. <br />0 Yes <br />El No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />0 Yes <br />0 No* <br />Was the testing apparatus properly calibrated? <br />0 Yes <br />El No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />0 N/A <br />El Yes <br />El No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />0 N/A <br />0 Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />N/A <br />or disconnected? <br />0 Yes <br />0 No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions <br />Z N/A <br />or fails a test? <br />E] Yes <br />El No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />Z N/A <br />Z Yes <br />0 No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />... —11 ­. .., VcAu", uc,ce euc BMW 41AU WIRCH tuese uenciencies were or will be corrected. <br />H. Comments: <br />Page 3 of 4 <br />UN -036 — 315 www.unidoes.org Rev. 01/17/08 <br />