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l <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 /> Complete the following checklist: <br /> ❑ Yes ❑ No* Has all input 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 property? <br /> ❑ Yes ❑ Me Were all 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: 0 3 g.p.h.; [10.1 g.p.h; ❑0.2 g.p.h. <br /> 0 Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> 0 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 /> N/A <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 /> N/A <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 /> N/A <br /> ❑ Yes ❑ No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> 0 N/A <br /> Yes ❑ No' Were all items on the equipment manufacturers 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 3 28 13 pass <br /> ENIVIRCIRInAENTAI HEAIT <br /> DEPARTMENT <br /> Monitoring System certification Page 3 of 4 2/21/07 <br />