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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 pertorm leak detection monitoring. Complete the following checklist: * In Section H, below, describe how and when these deficiencies were or will be corrected. Line Leak Detectors (LLD): (:mm�lntc fha fnllnwinn rharklicf� ❑ Check this box if LLDs are not installed. ® Yes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ® Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? ® Yes ❑ No* Was accuracy of system product level readings tested? ® Yes ❑ No* Was accuracy of system water level readings tested? ® Yes ❑ No* Were all probes reinstalled properly? ® Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? For electronic LLDs, have all accessible wiring connections been visually inspected? ® Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In Section H, below, describe how and when these deficiencies were or will be corrected. Line Leak Detectors (LLD): (:mm�lntc fha fnllnwinn rharklicf� ❑ Check this box if LLDs are not installed. * In Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: Monitoring System Certification Page 3 of 4 2/21/07 ® Yes ❑ No* ❑ N/A For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all 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? ® Yes ❑ No* Was the testing apparatus properly calibrated? ® Yes ❑ No* ❑ N/A For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ Yes ❑ No* ® N/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑ Yes ❑ No* ® N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? ❑ Yes ❑ No* ® N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? ❑ Yes ❑ No* ® N/A For electronic LLDs, have all accessible wiring connections been visually inspected? ® Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: Monitoring System Certification Page 3 of 4 2/21/07