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Onitoring System Certification <br /> Site Address: 153 E 11TH ST Date of Testing/Service: 0210$12005 <br /> QC-D-3 <br /> F. In-Tank Gauging 1 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 EINo* 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 0 No* Was accuracy of system water level readings tested? <br /> Yes No` Were all probes reinstalled properly? <br /> ®Yes []No` Fere all items on the equipment manufacturers'maintenance checklist completed? <br /> *In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors (LLD) : El Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> For equipment start-up or annual equipment certification,was a Teak simulated to verify LLD performance? <br /> ®Yes No* NIA (Check all that apply)Simulated leak rate: ® 3 g.p.h u 0,1 g.p.h 00.2 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 /> M Yes u No' ❑N/A For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> Yes E]No* M N/A For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> Yes ONo* ®NIA For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> Yes ONo" ®N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> Yes [:]No* M NIA For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> nYes ONo* Were all items on the equipment manufacturers'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 3 Based on CA form dated 03101 <br />