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F. In-Tank Gauging/SIR Equipment: E] Check this box if tank gauging is used only for inventory control. <br /> [] Check this box it no tank gauging or SIR equipment is installed. <br /> This section must be completed it in-tank gauging equipment is used to perform leak detection monitoring. <br /> Complete the following checklist: <br /> ❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> ❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> E] Yes rl No* Was accuracy of system product level readings tested? <br /> E] Yes [] No* Was accuracy of system water level readings tested? <br /> [] Yes 0 No* Were all probes reinstalled properly? <br /> tLL:1[] No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> *In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors(LLD): B Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> El Yes No* For equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance? (Check all <br /> H N/A that apply) Simulated leak rate:]3 g.p.h.;E]0A g.p.h ;[]0.2 g.p.h. <br /> Yes No' were all LLDs confirmed operational and accurate within regulatory requirements? <br /> Yes -No' Was the testing apparatus properly calibrated? <br /> Yes No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> N/A <br /> El Yes No' For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> NA <br /> Yes No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or <br /> N/A disconnected? <br /> Yes ® No' For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or <br /> N/A fails a test? <br /> Yes No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> H N/A <br /> El Yes 10 No* I Were all items on the equipment manufacturer's maintenance checklist completed? <br /> In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> 1c:D <br /> H. Comments: RECI� ss <br /> SEP 0 9 2017" <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> Monitoring System Certification Page 3 of 4 12/07 <br /> 3 2/2 1 A)7 <br />