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UNDERGROUND STORAGE TAMC MONITORING SYSTEM CER=CATION <br /> in-Tank Gauging / SIR Equipment: Permit Number: <br /> F. <br /> Zi Check this box if tank gauging is used only for inventory control_ <br /> ❑ Check this box if no tans:gauging or SIR equip nt is installed <br /> Tris section must be, completed if in-tanL ga ` ng equipment is used to perform leak deieciion moniioring. <br /> Complete the following checklist: <br /> ❑ Yes ❑ No* Has all input wiring been ins ected for proper entry and termination,including testine for ground faults? <br /> ❑ Yes ❑ No* Were all tank gauging probes 'sually inspected for damage and residue buildup? <br /> ❑ Yes ❑ No* Was accuracy of system product el readings tested? <br /> ❑ Yes I ❑ No* Was accuracy of system water level re as tested? <br /> ❑ Yes ❑ No* Were all probes reinstalled properly? <br /> ❑ Yes ❑ No* Were all items on the equipment manufacturer's aintenance checklist completed? <br /> *In Section H below,describe how and when these deficiencies were r will be corrected. <br /> G. Eine Leak Detectors (LLD): C] Check this box if LLDs e not installed. <br /> Com let e the following checklist: <br /> ❑ Yes ❑ No* For equipment start-up or annual equipment gertification, 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 /> ❑ Yes ❑ No* Were all LLDs confirmed operational d/accurate within regulatory requirements? <br /> ❑ Yes ❑ No* Was the testing apparatus properly ibrated? <br /> ❑ Yes ❑ No* For mechanical LLDs,.does the Lr <br /> restrict product flow if it detects a leak? <br /> ❑ N/A <br /> ❑ Yes ❑ No* For electronic LLDs, does the ine automatically shut off if the LLD detects a leak? <br /> ❑ N/A <br /> Z) Yes 71 No* For electronic LLDs, does the turb automatically shut off if any portion of the monitoring system is disabled <br /> ❑ NIA or disconnected? <br /> ❑ Yes ❑ No* For electronic LLDs, does the turbine auto \y shut off.f any portion of the monitoring system malfunctions <br /> ❑ NIA or fails a test? <br /> ❑ Yes ❑ No* For electronic LLDs,have all accessible wiring cont ections been visually.inspected? <br /> ❑ NIA <br /> ❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> *In Section I-i below,-describe how and when these deficiencies were or will be corrected. <br /> 1-1. Comments: <br /> jj <br /> DEH'HM-9301 (Rev 08/02). Page 3 of 4 County of San Diego-DEH-Hazardous Materials Division. <br />