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, .. �.. <br /> Monitoring System Certification <br /> NOV 18 2016 <br /> F. In-Tank Gauging/SIR Equipment: ® Check this box if tankau in i 71 <br /> g g g g.Vsed.only:fgailrvenxb"ry' eohfrul: TH <br /> ❑ Check this box if no tank gaugirig of 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 inNribeh,,11,d.henth <br /> been inspecteEderidenewswreor <br /> er entry and tMbe,,rected <br /> including testing for <br /> g ground faults. <br /> ❑ Yes ❑ No* Were all tg probes visucted for damap? <br /> ❑ Yes ❑ No* Was accutem product lgs tested?❑ Yes ❑ No* Was accutem water levtested?❑ Yes ❑ No* Were all ptalled proper❑ Yes ❑ No* Were all iequipment mer's maintenaed? <br /> *In the Section H,below,describe how and when thncies were or will be corrected. <br /> G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. <br /> Com tete the following checklist: <br /> ® Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br /> ❑ N/A (Check all that apply) Simulated leak rate: ®3 g.p.h.; ❑ 0.1 g.p.h; ❑0.2 g.p.h. <br /> ® Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> E Yes ❑ No* Was the testing apparatus properly calibrated? <br /> ❑ Yes ❑ No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> ® N/A <br /> ® Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ❑ N/A <br /> ® Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> ❑ N/A or disconnected? <br /> ® Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions <br /> ❑ N/A or fails a test? <br /> ® Yes ❑ No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> ❑ N/A <br /> ® Yes 1 ❑ No* Were all itemson the equipment manufacturer's maintenance checklist completed? <br /> *In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> Page 3 of 4 <br />