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0 RECEIVEV, <br />F. In -Tank Gauging / SIR Equipment: 0 Check, this box if tank gaup-im-, is used only for inventory control. <br />El Check this box if no tank gauging or SIR equipment is instal 2.0 2015 <br />This section must be completed if in -tank gauging equipment is used to perform leak detect't rh' () <br />MENTAL, <br />Complete the following checklist: WVr1j'1CDAO'r4ACAir <br />• Yes <br />0 No* <br />Has all input wiring been inspected for proper entry and termination, including testing for -round faults? <br />• Yes <br />E] No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />• Yes <br />0 No* <br />Was accuracy of system product level readings tested? <br />• Yes <br />0 No* <br />Was accuracy of system water level readings tested? <br />............... .. - <br />• Yes <br />171`.' <br />Were all probes reinstalled properly? <br />M Yes <br />0 No* <br />Were all items on the equipment manufacturer's maintenance checklist completed'? <br />* In the Section H. below, describe how and when hese deficiencies were or will be corrected. <br />G. Line Leak Detectors (LLD): [] Check this box if LLDs are not installed. <br />* In the Section H, below, describe how and when these deficiencies were or will be corrected. <br />Monitoring Certification Test Report <br />of 5 <br />Ej No* <br />For equipment nt start- up or annual equipment certification, was a leak simulated to verify LLD performance? <br />0 N!'A <br />(Check all that app4v) Simulated leak rate: 03 g.p.h.. 0 0.1 g.p.h , 0 0,2 g.p.h. <br />Z Yes <br />0 No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />Z Yes <br />0 No* <br />Was the testing apparatus properly calibrated? <br />Z Yes <br />[I No* <br />For mechanical Ll.,Ds, does the LLD restrict product flo" if it detects a leak'� <br />0 NA <br />0 Yes <br />0 No* <br />For electronic LLD& does the turbine automatically shut off at the LLD detects a leak"? <br />9 N/A <br />El Yes <br />0 No* <br />For electronic LLDs. does the turbine automatically shut off if any portion ofthe monitoring system is disabled <br />9 N/A <br />or disconnected" <br />17 Yes <br />0 No* <br />For electronic LLDs, does the turbine autornatically shut off if any portion of the monitoring system <br />0 N/A <br />malfunctions or fails a test? <br />10 Yes <br />[] No* <br />--------- ---- I <br />For electronic 1. .Ds, have all accessible wiring connections been visually inspected? <br />C1 N/A <br />I <br />0 Yes <br />0 No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? H <br />* In the Section H, below, describe how and when these deficiencies were or will be corrected. <br />Monitoring Certification Test Report <br />of 5 <br />