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9715517888 Line 1 <br />im GErrm-RYAN INC. <br />14:53:51 09-11-2014 414 <br />GR Job # 20-602042 <br />F. In -Tank Gauging / SIR Equipment: ff 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 />Cmmnlata fha fnllnwlnn rha kaam. <br />UC 401re"Ca. <br />G. Line Leak Detectors (LLD): ix Check this box if LLDs are not installed. <br />Comolete the fnilnwlnn ehar_Nlut- <br />❑ <br />es <br />❑ <br />o <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />Yes <br />❑ <br />NQ* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />rX <br />Yes <br />❑ <br />No' <br />Was accuracy of system products level readings tested? <br />rX <br />Yes <br />❑ <br />No' <br />Was accuracy of system water level readings tested? <br />IR <br />Yes <br />❑ <br />No` <br />Were all probes reinstalled properly? <br />Yes <br />❑ <br />No' <br />Were all Items on the equipment manufacturers maintenance checklist completed? <br />UC 401re"Ca. <br />G. Line Leak Detectors (LLD): ix Check this box if LLDs are not installed. <br />Comolete the fnilnwlnn ehar_Nlut- <br />❑ <br />Yes <br />® <br />o <br />or equipment start-up or annual equipment certification. was a leak simulated to verify D perforrrlance? (cher a 1 <br />❑ <br />NIA <br />that apply) Simulated leak rate: ❑ 3 g.p,h. ❑ 0.1 g.p.h. ❑ 0.2 g.p.h. <br />[] <br />Yes <br />❑ <br />No" <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />13 <br />Yes <br />❑ <br />No" <br />Was the testing apparatus property calibrated? <br />I] <br />Yes <br />❑ <br />No* <br />For Mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ <br />NIA <br />❑ <br />Yes <br />❑ <br />No' <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />❑ <br />N/A <br />❑ <br />Yes <br />❑ <br />No" <br />For electronic LLDs, does the turbine automatically shut off If any portion of the monitoring system is disabled or <br />❑ <br />NIA <br />Disconnected? <br />❑ <br />Yes <br />❑ <br />No' <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or <br />❑ <br />NIA <br />falls a test? <br />[3 <br />No* <br />For electronic LLDs, have all accessible wiring connections been visual inspected? <br />j❑Yes <br />EI <br />NIA <br />Yes <br />❑ <br />No` <br />were all items on the equipment manufacturer's maintenance checklist completed? <br />n t o .4Q—ti— <br />alma, el -4h. <br />G. Comments: <br />AIM <br />Monitoring System Certification Page 3 of 4 <br />17!07 <br />3 <br />