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0 6 <br /> F. in-Tank Gauging/SIR Equipment: E] 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 in-tank gauging equipment is used to perform leak detection monitoring. <br /> ate the followingohecktist: <br /> L7 Yes ❑ No' Hes an input wiring been Inspected for proper entry and terra€nation,including testing for ground faults? <br /> 0 Yes 113 NW Were an tarn gauging probes visually inspected for damage and residue buildup? <br /> 0 Yes I❑ Ne Was accuracy of system product level readings tested? <br /> 0 Yes 1❑ No' Was accuracy of system water level readings tested? <br /> fl Yes 113 No* Were all probes reinstalled properly? i <br /> F— <br /> =Yes 113 No' Were an items on the equipment manufacturer's maintenance checklist completed? 5 <br /> •In the Section H,below,desoribe how and when these de8cfenctes were or will be corrected. �Ep 0 r16 2017 <br /> G. Line Look Deleaftrs(LLD): p Check this box If LLDs are not installed. <br /> Complete the follwowinad:h t: - T L HEALTH <br /> Yes No' For equipment start-up or annual equipment certifipNon,was a teak simulated to verify LLC pe <br /> WA that sp*) Simulated leak rate.Q9 g.p.h.:❑0.1 g.p.h; 0.2 g p.h. <br /> Yes Ne Were an LLDs confirmed operational and accurate within regulatory requirements? <br /> Yes No' Was the testing apparatus property calibrated? <br /> Yes No` For mechanical LLDs,does the LLD restrict product flow If It detects a leak? <br /> NIA <br /> §7f:: <br /> Not For electronic LLDs,does the turbine automatically shut Oft if the LLD detects a leak? <br /> NIA <br /> ®Yes No' For electronic LLDs,does the turbine automatically shut off If any portion of the monitoring system Is disabled or <br /> NIA disconnected? <br /> 113 Yes No. For electronic LLDs,does the turbine automatically shut off If any portion of the monitcrIng system melfunct#one or <br /> NIA fails a test? <br /> YesLNI <br /> For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> Yea Were an Name on the equipment manufacturer's maintenance checklist completed? <br /> *11n the SectionK below,describe hawsdeldenoles were or will be dwroolied. <br /> H. Comments: <br /> Monitoring System Certlication Frage S of 4 MOT <br /> 2/21/07 <br />