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v <br />F In -Tank Gauging / SIR Equipment: X 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 />Comnlata the fnliroeinn ehwkirct- <br />❑ <br />Yes <br />❑ <br />No' <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />❑ <br />Yes <br />❑ <br />—ET—N-0- <br />No' <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />❑ <br />Yes <br />❑ Yes <br />Was accuracy of system product level readings tested? <br />❑Yes <br />X N/A <br />11No' <br />X Yes <br />Was accuracy of system water level readings tested? <br />11Yes <br />❑ <br />No- <br />Were all probes reinstalled property? <br />❑ <br />Yes <br />❑ <br />No <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />Lai <br />- In ins section H, below, describe how and when these deficiencies were or will be corrected. C <br />G. Line Leak Detectors (LLD): I- Check this box if LLDs are not installed. ENVIRONMENTAL <br />HEAITN nFpagTMFNT <br />Comoleta the fnllnwinn rhxkliat- <br />X Yes <br />❑ No' <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD (Check <br />❑ WA <br />performance? all <br />that apply) Simulated leak rate: X 3 g.p.h.; i_1 0.1 g.p.h ; ri 0.2 g.p.h. <br />X Yes <br />❑ No' <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />X Yes <br />❑ No' <br />Was the testing apparatus property calibrated? <br />❑ Yes <br />❑ No' <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />X N/A <br />X Yes <br />❑ No' <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />N/A <br />X Yes <br />_ No' <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or <br />-. N/A <br />disconnected? <br />X Yes <br />', No' <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails <br />ii WA <br />a test? <br />X Yes <br />L1 No' <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />N/A <br />X Yes <br />No' <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />nr rre Deemer n, rroruw, oeacnoe now am wren mese oenciencies were or win Oe correctea. <br />H. Comments: <br />Monitoring System Certification Page 3 of 4 12107 <br />3 <br />2/21/07 <br />