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WO-8842 <br /> Monitoring System Certification <br /> F. In-Tank Gauging/SIR Equipment: 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 perfion-n leak detection monitoring. <br /> Complete the following checklist: <br /> o* Has all input wring been inspected for proper entry and termination,including testing for ground faults? <br /> E]Yes 0 No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> []Yes []No* Was accuracy of system product level readings tested? <br /> 0 Yes oNo* Was accuracy of system water level readings tested? <br /> [3 Yes E]No* Were all probes reinstalled property'? <br /> ❑Yes E]No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> In the Section H,below,describe bow and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors (LLD): 0("heck this box if LLDs are not installed. <br /> Cam tete the falln ing checklist: <br /> [3 Yes ❑No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br /> ❑N/A Wheck all that appPv) Simulated leak rate: [3 3 g.p.h.: 0 0.1 g.p.h. [:]02 g.p.h. <br /> F1 Yes []No* Were all LLDs confirmed operational and accurate within regulatory requirements'! <br /> 0 Yes ONo* Was the testing apparatus properly calibrated'? <br /> 1 <br /> 0 Yes13No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> []N/A <br /> — <br /> 0, <br /> [:]Yes []No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak'! <br /> EIN/A <br /> 0 Yes []No* For electronic LLDs, does the turbine autornatically shut off if any portion of the monitoring system is disabled <br /> ON/A or disconnected? <br /> OYcs []No* For electronic LLDs,does the turbine automatically shutoff if any portion of the monitoring system malfunctions <br /> 13 N/A or fails a test? <br /> ❑Yes FlNo* For electronic LLDs,have all accessible wiring connections been visually inspected! <br /> ON/A <br /> [3 Yes ONo* Were all items on the equipment manufacturer's maintenance checklist completed'! <br /> In the Section H,below,describe how and when these deficiencies were or will he corrected. <br /> H. Comments: <br /> Only performed Functionality Test of the float and chain mechanism in dispenser#3/4-91 product, witnessed <br /> by Aaron Hang. <br /> Page 3 of 3 <br />