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RECD AUG 0 5 2015 <br />F. In -Tank Gauging/ SIR Equipment: • ❑ Check this box if tank gauglos 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 followina checklist: <br />Yes <br />❑ No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />Yes <br />r91 <br />❑ No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />Yes <br />❑ No* <br />Was accuracy of system product level readings tested? <br />Yes <br />E] No* <br />Was accuracy of system water level readings tested? <br />0 Yes <br />❑ No* <br />Were all probes reinstalled properly? <br />L-Ij Yes <br />❑ No* <br />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 be corrected. <br />G. Line Leak Detectors (LLD): W Check this box if LLDs are not installed. <br />Comnlete the followina checklist-- <br />F <br />hecklist: <br />❑ Yes <br />❑] No* <br />❑ N/A <br />For equipment start-up or annual equipment equipment eprcification, as a leak simulated to verify LLD performance? (Checkalt <br />that Simulated leak 3 ❑ 0.1 n 0.2 <br />apply) rate: g.p.h.; g., ; g.p.h. <br />Yes <br />No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />Yes <br />No* <br />Was the testing apparatus properly calibrated? <br />Yes <br />No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />N/A <br />Yes <br />No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />N/A <br />❑ Yes <br />No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or <br />H N/A <br />disconnected? <br />❑ Yes <br />No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or <br />N/A <br />fails a test? <br />❑ Yes <br />No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />N/A <br />YesU <br />No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In the Section H, below, describe how and when these deficiencies ware or will be corrected. <br />H. Comments: <br />Monitoring System Certification Page 3 of 4 12/07 <br />