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Mona ing System Certification <br /> to Address: 1103 S. MAIN ST. Date of Testing/Service: 06/03/2002 <br /> r. In—Tank Gauging / SIR Equipment ® 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 /> Yes ®No Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> ®Yes ®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 /> ❑Yes F_jNo Was accuracy of system water level readings tested? <br /> Yes ❑No Were all probes reinstalled properly? <br /> ®Yes EINo Were all items on the equipment manufacturers'maintenance checklist completed? <br /> *In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> Line Leak Detectors (LLD) ❑ Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> x Yes <br /> ®No [:]N/A For equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance? <br /> (Check all that apply)Simulated leak rate: x❑ 3 g.p.h ®0.1 g.p.h [:]0.2 g.p.h <br /> Yes E]No Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> X Yes 1:1 No Was the testing apparatus properly calibrated? <br /> ❑Yes F_JNo M N/A I For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> E]Yes QNo * ®N/A For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> MYes ❑No * ®N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> ❑Yes QNo * ®N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> XIYes No N/A For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> Yes [:]No Were all items on the equipment manufacturers'maintenance checklist completed? <br /> *In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> NOTE PLLD LINE LEAK DETECTOR DO NOT TRIP @3 GPH LEAK RATE. <br /> page 3 of 3 <br /> 1 <br />