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Monitoring System Certification-Page 3 of 3 <br /> Site Address: 1103 S. Main St Date of Testing/Servicing: 1/19/12 <br /> F. In -Tank Gauging/SIR Equipment: ISI Check this box if tank gauging is used only for inventory control. <br /> 0 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 teak detection monitoring. <br /> Corn lete the following checklist: <br /> ❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> 0 Yes 0 No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> O Yes 0 No* Was accuracy of system product level readings tested? <br /> 0 Yes 0 No* Was accuracy of system water level readings tested? <br /> ❑ Yes ❑ No* Were all probes reinstalled properly? <br /> 0 Yes 0 No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> *In Section H below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors(LLD): 0 Check this box if LLD's are not installed. <br /> Com lete the foliowin checklist: <br /> t& Yes 0 No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? <br /> 0 NA (Check all that apply) Simulated leak rate: 0 3 g.p.h.(1.); 0 0.1 g.p.h,(2.); ❑ 0.2 g.p.h.(2.). <br /> Notes: 1. Required for equipment start-up certification and annual certification.. <br /> 2. Unless mandated by local agency,certification required only for electronic LLD start-up. <br /> ® Yes ❑ No* Were all LLD's confirmed operational and accurate within regulatory requirements? <br /> M Yes 0 No* Was the testing apparatus properly calibrated? <br /> ❑ Yes 0 No* For mechanical LLD's,does the LLD restrict product flow if it detects a leak? <br /> z N/A <br /> I& Yes ❑ No* For electronic LLD's,does the turbine automatically shut off if the LLD detects a leak? <br /> ❑ N/A <br /> 0 Yes 0 No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> 0 N/A or disconnected? <br /> Do Yes 0 No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system <br /> 0 N/A malfunctions or fails a test? <br /> 9 Yes 0 No* For electronic LLD's,have all accessible wiring connections been visually inspected? <br /> O N/A/A <br /> Xes 0 NWere all items on the equipment manufacturer's maintenance checklist completed.? <br /> * In Section H below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br />