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J 9255517888 Line 1 01 <br />tJErrLER-RYAN INC. <br />:19:19 08-20-2012 4/4 <br />GR Job # 20-560569 <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 in -tank gauging equipment is used to perform leak detection monitoring. <br />Cmmnlntea tho fnlinurinn rhar_Irriet. <br />❑ <br />Yes <br />❑ <br />o <br />Has all input wiring been Inspected for proper entry and termination, Including testing for ground faults? <br />❑ <br />Yes <br />13 <br />No* <br />Were all tank gauging probes visually Inspected for damage and residue buildup? <br />❑ <br />Yes <br />❑ <br />NO* <br />Was accuracy of system products level readings tested? <br />[] <br />Yes <br />❑ <br />No* <br />Was accuracy of system water level readings tested? <br />0 <br />Yes <br />[I <br />No* <br />Were all probes reinstalled property? <br />j] Yes ❑ <br />No' <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. <br />Complete the foltowino rhorknah <br />f <br />es <br />❑ <br />o <br />For equipment start-up or annual equipment certification, was a leaK simulated toventyLLD performance? cher all <br />❑ <br />WA <br />that apply) Simulated leak rate: IR 3 g.p.h. ❑ 0.1 g.p.h. ❑ 0.2 g.p.h. <br />[i <br />Yes <br />❑ <br />No* <br />Were all LLDs confirmed operational and agate within regulatory requirements? <br />ff <br />Yes <br />❑ <br />NW <br />Was the testing apparatus property calibrated? <br />(] <br />Yes <br />❑ <br />NW <br />For Mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />ff <br />N/A <br />[tt <br />Yes <br />❑ <br />NW <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />❑ <br />N/A <br />rA <br />Yes <br />❑ <br />No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or <br />❑ <br />N/A <br />Disconnected? <br />U <br />Yes <br />❑ <br />No* <br />For elactronic Us, does the turbine automatically ally shut off if any portion of the monitoring system malfunctions or <br />® <br />N/A <br />fails a test? <br />IR <br />Yes <br />[3 <br />No* <br />For electronic LLDs, have all accessible wiring connections been visually Inspected? <br />❑ <br />N/A <br />E <br />Yes <br />❑ <br />No* <br />were all items on the equipment manufacturer's maintenance duettist completed? <br />uv uv® ua ... v .-, MOiP4v I '4 YUU WU Uanse uealGaeUGieB Were Or Will Re I-O..eumae. <br />G. Comments: <br />All ok... <br />*Only PLLD's were tested" <br />Monitoring System Certification Page 3 of 4 12107 <br />Cl <br />