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Aloni;teringSystem Certificniion <br /> 0ite Address: Date of Testino/Servicin / <br /> ;ax <br /> F. In-Tank Gauging/SIR Equipment: ❑ Cheek this box if tank gauging is used only for inventory control. <br /> Or-C-1-i—eck 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 /> V ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br /> ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ❑ No* Was accuracy ofsystem product level readings tested? <br /> ❑ No* Was accuracy of system water level readings tested? <br /> ❑ No* Were all probes reinstalled properly? <br /> ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> * In file Section It, below, describe how and when Ihese deficiencies were ur will be corrected. <br /> G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> Yes ❑ No* For equipment start-up or annual equipment cerh on, was a leak simulated to verify LLD performance? <br /> ❑ N/A (Check all that apply) Simulated leak rate: LX g�Cl 0.I g.p.h ; ❑ 0.2 g.p.h. <br /> L�rY ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> 14Yes ❑ 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 /> Cl Yes �❑ NN For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br /> l:r N/A <br /> Cl Yes ❑ Nom* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> p /A or disconnected? <br /> ❑ Yes ❑�Nom* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br /> �N/A malfunctions or fails a test? <br /> ❑ Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? <br /> Elol �A <br /> es ❑ No* Were all items on 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 3 05t00 <br />