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Monitoring System Certification - Page 3 of 3 <br />KtUt1V CU <br />NOV 2 3 2015 <br />ENVIRONMENTAL <br />NFAITU nCOAD ANCK T <br />Site Address: 610 S. Cherokee Ln. Date of Testing/Servicing: 10/26/15 <br />F. In - Tank Gauging / SIR Equipment: <br />m Check this box if tank gauging is used only for inventory control. <br />a 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 />Com lete the followin checklist: <br />0 Yes <br />0 No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />0 Yes <br />0 No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />0 Yes <br />0 No* <br />Was accuracy of system product level readings tested? <br />0 Yes <br />0 No* <br />Was accuracy of system water level readings tested? <br />Yes <br />❑ No* <br />Were all probes reinstalled properly? <br />❑ Yes <br />O No" <br />Were all items on the equipment manufacturees maintenance checklist completed? <br />" In Section H below, describe how and when these deficiencies were or will be corrected. <br />G. Line Leak Detectors (LLD): D Check this box if LLD's are not installed. <br />m Yes 0 No* i For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? <br />0 NIA I (Check ail that apply) Simulated leak rate: ® 3 g.p.h. (l.); 0 0.1 g.p.h. (2.); ❑ 0.2 g.p.h. (2.). <br />Notes: 1. Required for equipment start-up certificationnod annual certification. <br />2. 1 tnless mandated by local aeenev. certification required only for electronic LLD star -up. <br />W Yes <br />0 No* <br />Were all LLD's confirmed operational and accurate within regulatory requirements? <br />to Yes <br />0 No* <br />Was the testing apparatus properly calibrated? <br />m Yes <br />0 No* <br />0 N/A <br />For mechanical LLD's, does the LLD restrict product Flow if it detects a leak? <br />0 Yes <br />0 No* <br />m N/A <br />For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak? <br />0 Yes <br />0 No* <br />M N/A <br />For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />or disconnected? <br />0 Yes <br />0 No* <br />III N/A <br />For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system <br />malfunctions or fails a test? <br />0 Yes <br />0 No* <br />m N/A <br />For electronic LLD's, have all accessible wiring connections been visually inspected? <br />M Yes <br />0 No* <br />I Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In Section H below, describe how and when these deficiencies were or will be corrected. <br />H. Comments: <br />