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Underground Storage Tank <br /> Monitoring System Certification Form <br /> $: ;IN�TANK GAUGING TESTII�tG1 77777777 IF . 1 <br /> it <br /> XCheck this box if tank gauging is used only for inventory control . <br /> ❑ Check this box if NO tank gauging equipment is installed . Y10� 1 F NA; <br /> Do not complete this section if either box is checked. <br /> All wiring has been : 1 ) visually inspected for kinks , breaks and proper entry and termination ; ❑ ❑ ❑ <br /> and 2 ) tested for ground faults ? <br /> Were all in-tank gauging probes visually inspected for damage and residue buildup to ❑ ❑ <br /> ensure that floats move freely , functionally tested , and confirmed operational ? <br /> Was accuracy of system ' s product level readings tested ? ❑ ❑ ❑ <br /> Was accuracy of system ' s water level readings tested ? ❑ ❑ ❑ <br /> Were all probes reinstalled properly? ❑ ❑ ❑ <br /> Were all items on the equipment manufacturer's maintenance checklist completed ? ❑ ❑ ❑ <br /> Probe ID Probe Model Tanks Monitored Pass Fail <br /> IF <br /> IF ❑ ❑ <br /> ..COlWlt(E1V7SIF IF 77 <br /> Describe all answers marked "No " or "Fail" and proposed remedy. <br /> List all monitoring equipment either replaced or repaired. <br /> RECEIVED <br /> OCT 1 8 2022 <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> 'I Q , � Mbl�a'�pRIN� SITE I"�.AN <br /> Page 5 of 6 <br />