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❑ Check this box ff 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 properly? <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 /> Llne Leak Detectors(LLD): ❑ Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> S 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: S 3 9.Oh.; [10.1 g.p.h; [10.2 g.p.h. <br /> S Yes ❑ No' Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> S Yes ❑ No' Was the testing apparatus property calibrated? <br /> S Yes ❑ No' For mechanical LLDs,does the LLD restrict product Flow if it detects a leak? <br /> S N/A <br /> ❑ Yes ❑ No' For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> S 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 /> S N/A <br /> LOYessElNo' For electronicLLDs,does the turbine automatically shut off rf any portion of the monitoring system malfunctions or fails a test? <br /> S N/A <br /> s ElNo' Forelectronic LLDs,have all accessible wiring connections been visually inspected? <br /> N/A <br /> ❑ No" Were all items on the equipment manufacturers maintenance checklist wmpleted? <br /> In Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> 87140 3 28 21 PASS <br /> 91 160 4 26 12 PASS <br /> DSL 140 3 15 12 PASS <br /> Monitoring System Certification page 3 of 4 2/21/07 <br /> Monitoring System Certification <br />