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F. In-Tank Gauging f SIR Equipment: ® Check this box if tank gauging is used only for inventory control. <br /> ❑ 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 /> 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? MAR <br /> E Yes ❑ No' Were all items on the equipment manufacturer's maintenance checkfist completed? A <br /> In Section H,below,describe how and when these deficiencies were or will be corrected. EIRMONMENTIAL HEALTH <br /> Line Leak Detectors(LLD): ❑ Check this box if LLDs are not installed. PERIIAMSER V ICES <br /> Complete the following checklist: <br /> Yes ❑ No" For equipment start-up orannual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) <br /> ❑ N/A Simulated leak rate: Z 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 /> ❑ 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 /> S Yes ❑ No' For electronic LLDs,does the turbine automatically shutoff if any portion of the monitoring system is disabled or disconnected? <br /> ❑ N/A <br /> ® Yes ❑ No` For electronic LLD&,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> Lylml ❑ NIA <br /> y <br /> E] Nu" For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> ❑ N/A <br /> ❑ No' 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: SITE HAS 2 MECHANCIAL AND 1 ELECTRONIC PLLDS <br /> Monitoring System Certification Page 3 of 4 2/21/07 <br />