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Monitoring System Certification <br />Site Address: ­7c)cr_> -C_ 1� T's- <br />770- <br />plot�__ <br />F. In -Tank Gauging / SIR Equipment: <br />Date of L(>_/_( /Ak2b <br />U 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 -lank gauging eclLdpilient is used to perform leak detection monitoring. <br />Complete the following checklist: <br />F C❑ <br />13 Yes E3 No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults! <br />Yes <br />Yes <br />C1 Yes U No* Were all tank gauging probes visually inspected for damage and residue buildup? <br />Yes <br />C3 Yes 13 No* Was accuracy of system product level readings tested? <br />EC33Yes Q No* Was accuracy of system water level readings tested? <br />CI Yes 13 No* Were all probes reinstalled properly? <br />1— <br />U - Yes- 0 j — No* I Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In the Section H, below, describe [vow and wheii these deficiencies were or will be corrected. <br />G. Line Leak Detectors (LLD): Check this box if 1.1.1)s ire not instilled. <br />ComDlete the following checklist: <br />13 Yes <br />E3 No* <br />Q N/A <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance?: <br />(Check all that apply) Simulated leak rate: U 3 g.p.h.; El 0.1 g.p.h ; Q 0.2 g.p.h. <br />U'Yes <br />LI No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />0 Yes <br />U No* <br />Was the testing apparatus properly calibrated? <br />E3 Yes <br />0 No* <br />U N/A <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />(3 Yes <br />U No* <br />0 N/A <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />0 Yes <br />Q No* <br />Q N/A <br />For electronic LLDs, (foes the tin-hine intoinatically shut off if any portion of the monitoring system is disabled <br />or disconnected? <br />E3 Yes <br />0 No* <br />13 N/A <br />For electronic LLDs, does the tui -bine automatically shut off if any portion of the monitoring system <br />malfunctions or fails a test? 1 <br />13 Yes <br />U No* <br />L3 N/A <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />I <br />U Yes <br />1 <br />i <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />In the Section H. <br />7 <br />below. describe how and when these deficienel .9 were or will he rarrPetpd- <br />H. Comments: <br />Page 3 of 3 Os" I <br />