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0 <br />0 0 RECEIVED <br />F. in -Tank Gauging i SIR Equipment: ❑ Check this box if tank gauging is used only for inventory cwrt�r I RONMENT'AL <br />[3 Check this box if no tank gauging or SIR equipment is iins�AL�T%i DEPARTMENT <br />This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. <br />r.......iaaa ehn Mirnwinn ehar_klla4� <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 />❑ <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 />❑ <br />No* <br />Were all probes reinstalled properly? <br />❑ Yes <br />❑ <br />No* <br />Were aU items on the equipment manufacturer's maintenance checklist completed? <br />* in Section H, below, ciescnDe now ano wnen mese ueiwie,ic-w n®•o v, ..•�� +� ». •��a <br />Lina Lank Detectors (LLD): ❑ Check this box if LLDs are not installed. <br />Complete the MilowAingchecklist: <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) <br />0 Yes ❑ No* <br />❑ <br />N/A <br />Simulated leak rate: 0 3 g.p.h.; ❑ 0.1 g.p.h; ❑ 0.2 g.p.h. <br />0 Yes <br />❑ <br />No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />0 Yes <br />❑ <br />No* <br />Was the testing apparatus properly calibrated? <br />0 Yes <br />❑ <br />No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ <br />N/A <br />❑ Yes <br />❑ <br />No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />❑ Yes <br />0 <br />❑ <br />N/A <br />No. <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br />❑ Yes <br />0 <br />❑ <br />N/A <br />No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br />® <br />N/A <br />❑ Yes <br />❑ <br />No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />0 <br />N/A <br />® Yes <br />❑ <br />No* <br />i Were all items on the equipment manufacturer's maintenance checklist completed? <br />* in section H, below, oescnoe now ana wnen mese ...w•on..•c o ..�• ..• •-••• •-- --• <br />Comments: <br />87 120 3 25 21 PASS <br />81 140 3 28 22 PASS <br />nsi 4 An A 27 22 PASS <br />Monitoring System Certification Page 3 of 4 <br />2/21/07 <br />