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Monitoring System Certification <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 />CmmnlPte the fnllnwinn checklist: <br />❑ Yes <br />❑ <br />No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />❑ Yes <br />❑ <br />No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />e <br />❑ Yes <br />❑ Yes <br />❑ <br />❑ <br />No* <br />No* <br />Was accuracy of system product level readings tested? <br />Was accuracy of system water level readings tested? <br />❑ Yes <br />❑ <br />No* <br />Were all probes reinstalled properly? <br />❑ Yes <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In Section H, below, describe how and when these cienciencies were or win oe currcetcu. <br />G. Line Leak Detectors (LLD): <br />❑ Check this box if LLDs are not installed. <br />t-om fete <br />❑ Yes <br />the IUIIUWlllr <br />❑ No* <br />UIMUM113L. <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />❑ N/A <br />(Check all that apply) Simulated leak rate: ❑ 3 g.p.h.; ❑ 0.1 g.p.h ; [10.2 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 system 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 monitoring system malfunctions <br />❑ N/A <br />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 <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In Section H, below, describe how and when these deticiencies were or win oe currecteu. <br />H. Comments: Mechanical leak detectors not tested <br />Page 3 of 4 <br />UN -036 — 3/4 www.unidoes.org Rev. 01/17/08 <br />