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-'" <br /> Monitoring System Certification <br /> Site Address: (1ot(, t,a LSaE-- Date ofTestmrJServicing: ? I I <br /> F. In Tank Gauging/SIR Equipment: ❑ 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 m-tank gauging equipment is used to perform leak detection monitoring. <br /> Complete the following checklist: <br /> Yes ❑ No*. Has all iopdwidag been inspected for proper entry and termination,including testing for grotmd faults? <br /> es ❑ No* Were all tank gauging probes visually inspectecl for damage and residue buildup? <br /> • $•Yes O W. Was accuracy of system product level readings tested? <br /> .2-yes ❑ No* Was accuracy of system water level readings tested? <br /> fties <br /> cs E3 No* Were all probes.reinstalled properly? <br /> • (3 No*No* Were all itemon the equipment mar s maintenance.checklist competed? <br /> • `�In the Section K. below,describe how.and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors(LLD): ❑ Check this box if LLDs are not installed. <br /> Complete the following checklist , <br /> Fes <br /> ❑ No* For equipment start-up or annual equipment certification,was a leak-simulatr�d to verify LLD performance? <br /> ❑- N/A (Check n1l chert apply) Simulated leak rate:-CM-g ph; ❑0.1 g p h i O 02 g.pha <br /> Notes: 1. Required for equipment start-up certification and annual certification. .. <br /> '2'Unless mandated by local agency, ion.required only for electronic LLD start-up.• <br /> ❑ No* Were all L1.Ds confirmed operational and within regulatory requirements? <br /> 43 No* .Was the testing apparatus p calibrated?❑ No* Foe mechanical LLDs,does the LLD restrict product flow if it detectsa leak?NIA <br /> O No* -Ford 'c does the turbine automatically shut off ifthe LLD detects a leak? - <br /> N/A <br /> O Yes% a No* For electronic LLDs,does the turbine antomatimny shut off if any portion of the monitoring system is disabled <br /> -EMA or disconnected? <br /> ® Yeas ❑'No*' For electronic LLDs, does the.turbine automatically shut off if any.-.portion of.the;monitoring. system <br /> _Q •N/A malfunctions or fails a test? <br /> ❑ Yes O No* For electronic LLDs,have all accessible wiring connections bean visually inspected? <br /> /A <br /> Aa-rfes: O No* -Were all items on the equipment manuf mairees maintenance checklist completed? <br /> *In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> IL Comments: <br />