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GETTLER-RYAN INC. <br />FA <br />F. In -Tank Gauging / SIR Equipment: <br />10-06210" <br />r. <br />G 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 />Complete the following checklist: <br />Ia <br />Yes <br />13 <br />o <br />Has all Input wiring been Inspected for proper entry and termination, including testing for ground faults? <br />(i <br />Yes <br />❑ <br />No' <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />[L- <br />Yes <br />❑ <br />No' <br />Was accuracy of system products level readings tested? <br />Ej <br />Yes <br />❑ <br />No' <br />Was accuracy of system water level readings tested? <br />r& <br />Yes <br />❑ <br />No' <br />Were all probes reinstalled properly? <br />g <br />Yes <br />❑ <br />No" <br />lWere 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): ❑ Check this box if LLDs are not installed. <br />Complete the following checklist: <br />11, <br />Yes <br />13 <br />No'or <br />equipment start-up or annual equipment certification, was a leak simulated to verify LD performance? check all <br />❑ <br />N/A <br />that apply) Simulated leak rate: ® 3 g.p.h. ❑ 0.1 g.p.h. ❑ 0.2 g.p.h. <br />Ili <br />Yes <br />❑ <br />No' <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />I3 <br />Yes <br />❑ <br />No" <br />Was the testing apparatus properly calibrated? <br />❑ <br />Yes <br />® <br />No' <br />For Mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />ff <br />N/A <br />Ij <br />Yes <br />❑ <br />Nd <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 shutoff If any portion of the monitoring system is disabled or <br />❑ <br />N/A <br />Disconnected? <br />111 <br />Yes <br />❑ <br />No' <br />For electronic LLDs, does the turbine automatically shut ®R 9 any portion of the monitoring system malfunctions or <br />❑ <br />N/A <br />fails a test? <br />11 <br />Yes <br />❑ <br />Ne <br />For electronic LLDs, have all accessible wiring connections been visually inspected. <br />❑ <br />N/A <br />rg <br />Yes <br />1 ❑ <br />No' <br />were all items on the equipment manufacturers maintenance checklist completed? <br />In the gictloon H, below, describe ow a en these deficiencies were or will be corrected. <br />G. Comments: <br />Monitoring System Certification Page 3 of 4 12107 <br />