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`/ <br /> F. In-Tank Gauging I SIR Equipment: ® Check this box if tank gauging is used only for inventory control. <br /> ❑ Check this box'd no tank gauging or SIR equipment is installed. <br /> This section must be completed ff in-tank gauging equipment is used to perform leak detection monitoring. RECEIVED <br /> Complete the following checklist: <br /> El Yes [I No* Has all input wiring been inspected for proper entry and termination,inducting 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 readingstested? ENVIRONMEN L <br /> ® Yes ❑ No' Was accuracy of system water level readings tested? HEALTH DEPART ENT <br /> ® Yes ❑ No' Were all probes reinstalled property? <br /> ® Yes ❑ No' Were all items on the equipment manufacturer's maintenance checklist completed? <br /> In Section H,below,descdbe now antl when these deficiencies were or will be corrected. <br /> Line Leak Detectors(LLD): ❑ Check this box lf LLDs are not installed. <br /> Complete the follawin checklist: <br /> ® Yes ❑ No' For equipment start-up or annual equipment certification, was a leak simulated to verify LLD perform:ordi=jnneated? <br /> ly) <br /> ❑ N/A Simulated leak rate: ®3 g.p.h.; ❑0.1 g.p.h; [10.2 g.p.h. <br /> ® <br /> Yes ❑ No- Were all LLD.confirmed operational and accurate within regulatory requirements? <br /> ® Yes ❑ No- Was the testing apparatus property calibrated? <br /> ® <br /> as ® No' For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> ❑ NIA <br /> ❑ <br /> Yes ❑ Ne For electronic LLDS,does the turbine automatically shut of N the LLD detects a leak? <br /> ® N/A <br /> ❑ <br /> Yes ❑ NO. <br /> For electronic LLDs,does the turbine automatically shut off lf any porion of the monitoring system is disabN/A <br /> ❑ Ves ❑ No' For electronic LLDs,does the turbine automatically shut oR if any portion of the monitoring system malfun <br /> ® NIA <br /> ❑ Yes ❑ No' For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> ® N/A <br /> ® Yes ❑ No' Were all items on the equipment manufacturers maintenance checklist completed? <br /> In Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: 872 PE PETRO PLLD FAILED—To be repaired by others—G Kaiser. <br /> Monitoring System Certification Page 3 of 4 2/21/07 <br />