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lr_�_ U( ) <br /> F. in-Tank Gauging I SIR Equipment: ❑ Check this box if tank gauging Is used only for inventory control. <br /> 0 Check this box tf no tank gauging or SIR equipment Is installed. <br /> This section must be completed H In-tank gauging equipment is used to perform Leak detection monitoring. <br /> Complete the following checklist: <br /> 13Yes ❑ NO* Has all kaput wiring been inspected for proper entry and termination,including testing for ground faults? <br /> ❑ Yes ❑ No. Were all tank gauging probes visually Inspected for damage and residue buildup? <br /> ❑ Yes ❑ No. Was accuracy of system product level readings tested? <br /> ❑ Yes ❑ No* Was accuracy of system water level readings tested? <br /> ❑ Yes ❑ No* Were all probes reinstalled properly? <br /> ❑ Yes ❑ No* Were ail Items on the equipment manufacturer's maintenance checklist completed? <br /> 'In Section H,below,describe how and when these deficiencies were or will be corrected. <br /> Line Leak Detectors(LLD): ❑ Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> • Yes ❑ No' For equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance?(Check all that apply) <br /> ❑ N/A Simulated leak rate: 3 g.p.h.; [10.1 g.p.h; [10.2 g.p.h. <br /> • Yes ❑ No' Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> ® Yes ❑ No* Was the testing apparatus property calibrated? <br /> ® Yes ❑ No* For mechanical LLDs,does the LLD restrict product flow If It detects a leak? <br /> ❑ NIA <br /> ❑ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off If the LLD detects a leak? <br /> ® N/A <br /> ❑ Yes ❑ No' For electronic LLDs,does the turbine automatically shut off If any portion of the monitoring system is disabled or disconnected? <br /> ® NIA <br /> ❑ Yes ❑ No` For electronic LLDs,does the turbine automatically shut off If any portion of the monitoring system malfunctions or fails a test? <br /> 0 N/A <br /> ❑ Yes ❑ No` For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> N/A <br /> M Yes ❑ No* Were an items on the equipment manufacturer's maintenance checklist completed? <br /> "In Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. comments: LEAK DETECTOR +. <br /> 550 6 2718 PASS P <br /> DEC <br /> IHEALH <br /> DEPARI MENT <br /> Monitoring System Certification Page 3 of 4 2/21/07 <br />