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t 6EmER-RYAN INC. GR .Job # 10-062101.1 FA F. In -Tank Gauging / SIR Equipment: ❑ Check this box if tank gauging is used only for inventory control. ❑ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. Cern !eh the fnllnv inn rherklrst• In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. Cmmnlata tha fnllnwinn rhackltst ff Ij r es ❑ o Has all input wiring been inspected for proper entry and termination, Including testing for ground faults? 11 Yes ❑ No' Were all tank gauging probes visually inspected for damage and residue buildup? ❑ [3 Yes ❑ No' Was accuracy of system products level readings tested? No` ra Yes ❑ No' Was accuracy of system water level readings tested? For Mechanical LLDs, does the LLD restrict product flow if it detects a leak? Ij Yes ❑ No' Were all probes reinstalled properly? ff rg Yes 1 ❑ No' IWere ad items on the equipment manufacturers maintenance checklist completed? In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. Cmmnlata tha fnllnwinn rhackltst ff Yes ❑ o or equipment start-up or annual equipment certification, was a leak simulated to verify ormance? (check a# ❑ N/A that apply) Simulated leak rate: ® 3 g.p.h. ❑ 0.1 g.p.h. ❑ 0.2 g.p.h. Yes ❑ No' Were all LLDs confirmed operational and accurate within regulatory requirements? [j Yes ❑ No` Was the testing apparatus properly calibrated? [] Yes ❑ No` For Mechanical LLDs, does the LLD restrict product flow if it detects a leak? ff N/A ff Yes ❑ No' For electronic LLDs, does the turbine automatically shut off H the LLD detects a leak? ❑ N/A r, Yes ❑ No' For electronic LLDs, roes the turbine automatically shut off If any portion of the monitoring system is disabled or ❑ N/A Disconnected? Yes ❑ No' For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or ❑ N/A fails a test? Yes ® No" For electronic LLDs, have all accessible wiring connections been visually inspected? ® N/A Ij Yes 1 ❑ No' 1were all items on the equipment manufacturer's maintenance checklist completed? ' In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Comments: VIE G% OV ML) 2014 Monitoring System Certification Page 3 of 4 12107 WOAt 3