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Mloni!tering System Certification <br /> 9 <br /> Site Address: Date of Testing/Servicing: <br /> F. In-Tank. Gauging/ SIR Equipment: � Check this box if tank gatming is used only for inventory control- <br /> 11 <br /> ontrol_ <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 perfor111 leak detection monitoring. <br /> Complete the following checklist: <br /> Cl 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 /> Cl Yes ❑ No* Were all probes reinstalled properly? <br /> ❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> * In the Section H, 'below,describe how and wleen these deficiencies were or will be corrected. <br /> G. Line Leal.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 cc <br /> 54ification, 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 /> yeshEQ1N/Af Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> Y -- Was the testing apparatus properly calibrated? <br /> Yes ❑ Noor mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br /> Cl Yes 1 ❑ o* I Forelectronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br /> NIA <br /> ❑ Yes ❑ o-* 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 <br /> ,ZrN/A malfunctions or fails a test? <br /> ❑ Yes,, <br /> ❑ al` For electronic LLDs, have all accessible wiring connections been visually inspected? <br /> X7 N/A <br /> A Yes U 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 /> Pal;.3 of 3 05/00 <br />