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TjU6nitcring System Certification • _y Site Address: ; t; f � 0� ✓ "u' J�t�u NU00 DateoFTesting/Servicing: F. In -Tank Gauging / SIR Equipment: C7'Check this box if tank gauging is used only for inventory control. ❑ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: ❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? ❑ Yes ❑ No* Was accuracy of system product level readings tested? ❑ Yes ❑ No* Was accuracy of system water level readings tested? ❑ Yes ❑ No* Were all probes reinstalled properly? ❑ Yes 1 ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? " In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. Complete the following checklist: Yes 13No* For equipment start-up or annual equipment certation, was a leak simulated to verify LLD performance? ❑ N/A (Check all that apply) Simulated leak rate: 0 3'g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. ❑ Y o* Were all LLDs confirmed operational and accurate within regulatory requirements Ef Yes ❑ No* Was the testing apparatus properly calibrated? ET—Yes ❑ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ N/A ❑ Yes ❑ No* F lectronic LLDs, does the turbine automatically shut off if the LLD detects a leak? /A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled N/A or disconnected? ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system 3-1q/_A_� malfunctions or fails a test? ❑ Yes ❑ No* _..For electronic LLDs, have all accessible wiring connections been visually inspected? /A Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: )7-,(;? 7- 1; t-:<�.a !� �-a�f �t2,.�e�r.:e�' 41 ! Ir � ►� It SO ,�- � ,� *P ✓ . ('L I U' f' 2 t'� f /.. T Fa G" l ! t? f3(- <k r '7 �0{;5 1,V"P aPn6 f- of rSt Ife(j, . Page 3 of 3 05/00