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r] :I F- In -Tank Gauaino /SIR Eauioment: ❑ Check this box if tank gauging is used only for inv t t C E IVE D ❑ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. JAN 5 2016 Complete the following checklist: Yes [I No` Has all input wiring been inspected for proper entry and termination, including testing for ground faults? TAL MENT ` in Section m, Deiow, oescriDe now ano wnen LneSe uenciencie5 were ur winue GVrrecleu. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. ® Yes ElNo* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) ElYes El No; Were all tank gauging probes visually inspected for damage and residue buildup? ❑ Yes [INo* No* Was accuracy of system product level readings tested? ❑ Yes ElNo* No* Was accuracy of system water level readings tested? ❑ Yes [INo* No* Were all probes reinstalled properly? ❑ Yes ElNo* Were all items on the equipment manufacturer's maintenance checklist completed? ` in Section m, Deiow, oescriDe now ano wnen LneSe uenciencie5 were ur winue GVrrecleu. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. ® Yes ElNo* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) [IN/A Simulated leak rate: ® 3 g.p.h.; E]0.1 g.p.h ; [10.2 g.p.h. ® Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? ® Yes ❑ No* Was the testing apparatus properly calibrated? ® Yes ❑ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ElN/A ElYes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ® N/A ❑ Yes ElNo* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? ® N/A ❑ Yes ElNo* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? ® N/A ❑ Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? ® N/A ® Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: 87 120 3 25 21 PASS 91 140 3 28 22 PASS DSL 130 4 27 22 PASS Monitoring System Certification Page 3 of 4 2/21/07