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Mar 0.5 W 10:18a Reliable PetroleumA <br />Monitoring System Certification <br />209-845-8953 p.2 <br />F. III -Tank Gauging / SIR Equipment: W 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 />❑ No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground fauhs? <br />O Yes <br />❑ No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />O Yes <br />❑ No* <br />Was accuracy of system product level readings tested? <br />❑ Yes <br />❑ No* <br />Was accuracy of system water level readings tested? <br />❑ Yes <br />® No* <br />'%fere all probes reinstalled properly? <br />❑ Yes <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />Is ca:asvaa n, P. -r—, uCSCrlve now ana wnen tnese ctenciencies were or Will be corrected. <br />G. Line Leak Detectors (LLD): <br />Comntete the fnrtnwina ehesnklief. <br />❑ Check this box if LLDs are not installed. <br />19 Yes <br />❑ No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />O N/A <br />(Check all that apply) Simulated leak rate: ® 3 g.p h.; ❑ 0.1 g p.h ; ❑ 0.2 g.p.h. <br />0 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 />❑ NIA <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak`? <br />® NIA <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />0 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 malfunctions <br />® NiA <br />or fails a test? <br />❑ Yes <br />❑ No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />® N/A <br />0 Yes <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />Yn Section <br />ri_ hetnw. <br />dPce+riha hnw .-A ...e..... 41..,-� <br />Ws -w VA wall UC CVrrec[eu. <br />Page 3 of 4 <br />EIN-036 - 3/4 www.uoido s.oa <br />cgr Rev. 01/17/08 <br />