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0 <br />F. I.n-Tank Gauging / SIR Equipment: <br />® Check this box if tank gauging is used only for inventory contro . <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 monit ging. <br />Complete the following checklist: <br />❑ Yes <br />❑ No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground ft,ults? <br />❑ Yes <br />❑ No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />❑ Yes <br />❑ No* <br />Was accuracy of system product level readings tested? <br />❑ Yes <br />❑ No* <br />Was accuracy of system water level readings tested? <br />❑ Yes <br />❑ No* <br />Were all probes reinstalled properly? <br />❑ Yes <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? NOV 16 2015 <br />* In the Section <br />H. <br />below. descrihe hnw anti when *NPCP f1Pf*P:P M L. J <br />G. Line Leak Detectors (LLD): <br />Complete the following checklist: <br />❑ Check this box if LLDs are not installed. <br />® Yes <br />❑ No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD )erformance? <br />❑ N/A <br />(Check ull that apple) Simulated leak rate: ®3 g.p.h.; ❑ 0.1 g.p.h . ❑ 0.2 g.p.h. <br />® Yes <br />❑ No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />® Yes <br />❑ No* <br />Was the testing apparatus properly calibrated? <br />® Yes <br />❑ No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ N/A <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />® N/A <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring syste n is disabled <br />® N/A <br />or disconnected? <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitln•ing system <br />® N/A <br />malfunctions or fails a test? <br />® Yes <br />❑ No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />❑ N/A <br />® Yes ❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* in the caption H <br />b 1 d <br />, e ow, eserobe now and when these deficiencies were or will be corrected. <br />H. Comments: <br />Monitoring Certification Test Report <br />3 of 5 <br />