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F. 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 perform leak detection monitoring. r:mm�lr+tp the following checklist: * In the Section H, below, describe now and wnen tnese aencrencres were or wm oe correca ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) Simulated leak rate: x 3 g.p.h.; ❑ 0.1 g.p.h ; 110.2 g.p.h. x Yes ❑ Yes x No* Were all tank gauging probes visually inspected for damage and residue buildup? ❑ No* ❑ Yes x No* Was accuracy of system product level readings tested? x Yes ❑ Yes x No* Was accuracy of system water level readings tested? ❑ Yes x No* Were all probes reinstalled properly? x Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑ Yes ❑ No* x N/A ea. G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. Complete the following checklist: ❑ 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: x 3 g.p.h.; ❑ 0.1 g.p.h ; 110.2 g.p.h. x Yes x Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? x Yes ❑ No* Was the testing apparatus properly calibrated? x Yes ❑ No* ❑ N/A For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ Yes ❑ No* x N/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑ Yes ❑ No* x N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? ❑ Yes ❑ No* x 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* x N/A For electronic LLDs, have all accessible wiring connections been visually inspected? x Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H. below, describe how and when these deficiencies were or will be corrected. H. comments: See leak detector form Monitoring System Certification Page 3 of 4 Eelr� 3 2/21 /07