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Moni. ring System Certification <br /> Site Address: 1103 S. MAIN ST. Date of Testing/Service: 06/03/2002 <br /> P. In-Tank Gauging / SYR 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 /> ElYes ❑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 No Was accuracy of system water level readings tested? <br /> Yes ❑No Were all probes reinstalled properly? <br /> Yes E]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 /> Line Leak Detectors (LLD) ❑ Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> MY.s ❑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 /> F-1 Yes No Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> MX Yes ❑No Was the testing apparatus properly calibrated? <br /> ®Yes ®No ❑x N/A For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> Yes QNo * ®N/A For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> MYes ❑No * M N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> ®Yes [DNo * ❑N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> MY.. ❑No * ❑N/A For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> E]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 />