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Monitoring System Certification-Page 3 of 3 <br /> Site Address: 2705 Country Club Blvd. Date of Testing/Servicing: 617/18 <br /> F. In -Tank Gauging/SIR Equipment: N Check this box if tank gauging is used only for inventory control. <br /> 0 Check this box if no tank gauging or SIR equipment is installed. <br /> C, <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. <br /> Complete the folio ing checklist: <br /> 0 Yes [i No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> [I Yes 0 No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> 0 Yes 0 No* Was accuracy of system product level readings tested? <br /> 0 Yes 11 No* Was accuracy of system water level readings tested? <br /> 0 Yes 11 No* Were all probes reinstalled properly? <br /> 0 Yes I El No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> *In Section H below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors(LLD): 0 Check this box if LLD's are not installed. <br /> Complete the folio ing checklist: <br /> 0 Yes 0 No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? <br /> 11 N/A (Check all that apply) Simulated leak rate: 19 3 g.p.h. (L); El 0.1 g.p.h.(2.); 0 0.2 g.p.h.(2.). <br /> Notes: 1. Required for equipment start-up certification and annual certification. <br /> 2. Unless mandated by local agency,certification required only for electronic LLD start-up. <br /> Im Yes 0 No* Were all LLD's confirmed operational and accurate within regulatory requirements? <br /> Do Yes 0 No* Was the testing apparatus properly calibrated? <br /> 0 Yes 0 No* For mechanical LLD's,does the LLD restrict product flow if it detects a leak? <br /> 0 N/A <br /> 0 Yes 0 No* For electronic LLD's,does the turbine automatically shut off if the LLD detects a leak? <br /> IM N/A <br /> 0 Yes 11 No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> H N/A or disconnected? <br /> 0 Yes 0 No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system <br /> 11 N/A malfunctions or fails a test? <br /> 0 Yes 0 No* For electronic LLD's,have all accessible wiring connections been visually inspected? <br /> im N/A <br /> N Yes 1 13 No* 1 Were all items on the equipment manufacturer's maintenance checklist completed? <br /> In Section H below,describe bow and when these deficiencies were or will be corrected. <br /> H. Comments: <br />