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imGfrTiER-RYAN INc. GR Job # 1820- 1786 <br /> S WRCB,January 2006 <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 /> 0 es I ❑ o 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 products level readings tested? <br /> ❑ Yes ❑ No* Was accuracy of system water level readings tested? — e °ia" <br /> 0 Yes ❑ No' Were all probes reinstalled properly? <br /> 21 Yes 1 ❑ No Were 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. ENVIRONMENTAL. <br /> HEA.I_TH DEPARTMENT <br /> Complete the following checklist <br /> Yes ❑ o or egwpmen start-up or annual equipment certification,was a leak simulated o verify performance (check all <br /> ❑ N/A that apply) Simulated leak rate: ❑ 3 g.p.h. ❑ 0.1 g.p.h. ❑ 0.2 g.p.h. <br /> 0 Yes ❑ No' Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> ❑ Yes ❑ No* Was the testing apparatus properly 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 <br /> ® N/A Disconnected? <br /> ❑ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or <br /> 0 N/A fails a test? <br /> ❑ Yes ❑ No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> ® N/A <br /> ® Yes ❑ No* were all items on the equipment manufacturers maintenance checklist completed? <br /> In the Section H,below,describe how and when these defliciencles were or will be corrected. <br /> G. Comments: <br /> Monitoring System certification Page 3 of 4 12/07 <br /> 3 <br />