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Monitoring System Certification <br />F. In -Tank Gauging / SIR Equipment: <br />E <br />® Check this box if tank gauging is used only for inventory control. <br />F1 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 />0 Yes <br />0 No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />0 Yes <br />0 No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />0 Yes <br />0 No* <br />Was accuracy of system product level readings tested? <br />0 Yes <br />0 No* <br />I Was accuracy of system water level readings tested? <br />E3 Yes <br />0 No* <br />Were all probes reinstalled properly? <br />0 Yes 0 No* <br />*7 <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />.. Complete the following checklist: <br />were or win ne corrected. <br />El Check this box if LLDs are not installed. <br />0 Yes <br />0 No* <br />1 <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />0 N/A <br />(Check all that apply) Simulated leak rate: [13 g.p.h.; F-1 0.1 g.p.h ; El 0.2 g.p.h. <br />0 Yes <br />0 No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />0 Yes <br />0 No* <br />Was the testing apparatus properly calibrated? <br />0 Yes <br />0 No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />El N/A <br />0 Yes <br />0 No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />Z N/A <br />0 Yes <br />0 No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />Z N/A <br />or disconnected? <br />0 Yes <br />0 No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions <br />IZ N/A <br />or fails a test? <br />0 Yes <br />0 No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />0 N/A <br />0 Yes <br />(:1 No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />in Rt-etinn <br />14 hAln— <br />.to L_- ___3 ---L-_ . <br />H. Comments: <br />- -- -- - --- .. ^__-- •• ..+._ .++w...,..■s.,acua.iw WWI vur Will De correctea. <br />Page 3 of 4 <br />UN -036 — 3/4 <br />www.unidocs.org Rev. 01/17/08 <br />