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F. In -Tank Gauging / SIR Equipment: <br />0 <br />❑ 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 <br />❑ <br />No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />❑ Yes <br />❑ <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 />❑ <br />No* <br />Was accuracy of system water level readings tested? <br />❑ Yes <br />I ❑ <br />No* <br />Were all probes reinstalled properly? <br />❑ Yes <br />1 T <br />1 ❑ <br />No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />uI V.., c a1VW auu w11C11 u►ebe umiumicles were or wall be corrected. <br />G. Line Leak Detectors (LLD): <br />Comnlete the following checklist - <br />0 Check this box if LLDs are not installed. <br />® Yes <br />❑ No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />❑N/A <br />Check all that a 1) Simulated leak rate: ®3 .h. ❑ 0.1 .h ; ❑ 0.2 .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 <br />❑ N/A <br />or disconnected? <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br />❑ N/A <br />malfunctions or fails a test? <br />❑ Yes <br />❑ No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />❑ N/A <br />® Yes <br />❑ No* I <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />- in the aection x, below, describe how and when these deficiencies were or will be corrected. <br />H. Comments: <br />Page 3 of 3 <br />Monitoring System Certification <br />