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aGFrui=R-RYAN IHC. GR Job# <br /> 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 /> nyder oatrevuu <br /> This section must be completed if In-tank gauging equipment is used to perform leak detection monitoring <br /> x <br /> Complete the following checklist: <br /> [] yes „L] o Has all Input wiring been inspected for proper entry and termination Including testing for ground faults? <br /> I] Yes [] Nn` Were all tank gauging probes visually Inspected for damage and residue buildup? j <br /> Q Yes ❑ No' Was accuracy of system products level readings tested? <br /> l] Yes ❑ No' Was accuracy of system water level read ngs tested? <br /> Yes ❑ No' Were all probes reinstalled property? <br /> [] Yes x❑ Na' lWere 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); 0 Check this box if LLias are not installed, <br /> Complete the following checklist: <br /> Yes ❑ or equipment start-up or annual equipmentcerlincalion,was a leaks mulat6d to veriry 1.1.0-performance7icheck all <br /> ❑ <br /> NIA that apply) Simulated leak rate ® 3 g.p h ❑ 0 1 g p h ❑ G 2 g.p.h. <br /> ❑ Yes E 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 It It detects a leak? <br /> NIA <br /> I-L Yes ❑ No' For electronic LLDs,does the turbine automatically shut off If the LLD detects a leak? j <br /> 0 NIA <br /> Yes 0 No' For electronic LLDs,does the Curb ne automatically shut off f any portion of the monflodng system is disabled or <br /> ❑ NIA Dlsconnected7 <br /> ❑ No' For of branic LLDs,does the turbine automatically shut off if any portion of the mcnilortng system malfunctions or <br /> ❑ NIA faits a test? <br /> [L- Yes ❑ No' For electronic LLDs,have all accessible wiring connections been visuaI4 inspected? <br /> ❑ N/A <br /> U 11 Yes [3 No' were all items on the equipment manufacturer's maintenance checklist compfeled7 <br /> in theSection H,below,describe how and when Lhasa deficiencies were orwill be corrected. <br /> G. Comments: <br /> Only tested the diesel leak detector.Tested from furthest lisp.Test passed, tested a <br /> second time,which also passed, <br /> t> k <br /> Monitoring System Certification Page 3 of 4 13W <br /> 3 <br />