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nitoring System Certification <br /> Site Address: 4747 WEST LANE Date of Testing/Service: 03/26/2001 <br /> F. In-Tank Gauging / 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 /> This section must be completed if in-tank gauging equipment is used to preform leak detection monitoring <br /> Complete the following checklist: <br /> E] Yes F-1No• Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br /> EJ Yes F-]No• Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ❑ Yes 7No• Was the accuracy of system product level readings tested? <br /> ❑Yes ❑No• Was accuracy of system water level readings tested? <br /> ❑ Yes ❑No- Were all probes reinstalled properly? <br /> ❑ Yes I DNo.I Were all items on the equipment manufacturers maintenance checklist completed? <br /> G. Line Leak Detectors (LLD) : ❑ Check this box if no tank gauging or SIR equipment is installed. <br /> Complete the following checklist: <br /> or equipment start-up or annual equipment certification,was a leak simulated75­v_eFf7U13 performance. <br /> ® Yes ❑No• 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 and accurate within regulatory requirements? <br /> ® Yes M No• Was the testing apparatus properly calibrated? <br /> ®Yes ®No• N/A For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> ❑Yes ❑No N/A For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ©Yes No• N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected <br /> Yes No• N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test <br /> ®Yes []No• N/A or electronic LLDs,have all accessible wiring connections been visually inspected? <br /> El Yes FINo• Nere all items on the equipment manufacturers maintenance checklist completed? <br /> In the Section H, below,describe how and when these deficiencies were orwill be corrected. <br /> H. Comments: <br /> page 3 of 3 <br />