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Monitoring System Certification <br /> JUL 31 2014 <br /> F. In-Tank Gauging/SM Equipment., ® Check this box if tankau in is 4J I <br /> g g g <br /> ❑ HEALTH <br /> Check this box if no tank gauging or SIR equip pmlj' <br /> -tank gauging equipment is used to perform leak detection moaitorin <br /> This section trust be complcicd if in t +1 <br /> Complete the following checklist: <br /> Cl Yes D leo* Bas all input wiring heen inspected for proper entry and termination,including testhig for ground faults? <br /> ❑ Yes ❑ No* Were all tank gausiug probes visually inspected for damage and residue buildup? <br /> Q Yes ❑ No' Was accuracy of system product level readings tested? <br /> ❑ Yes ❑ No*" Was accuracy of system water level readings tested? <br /> O Yes El No* Were all probe,,,reinstalled properly? <br /> ❑ Vcs ❑ Nos Were all items on the equipmen[manufacturer's maintcnanec checklist completed? <br /> "la the Section K below,describe how and when these deficiencies were or will be currected. <br /> G. Line Leak Detectors (LLI)): r,) Check this box if LLus are not installed. <br /> Com lete the folio Ing checklist: <br /> ® Yes D No For equipmeat start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br /> Q NIA (Check all(hat apply) Simulated leak rate: ®3 g.p.h_ ❑0.1 g•p.h; ❑4.2 g.p.h. <br /> ® Yes ElNo* Were all LLDs confirmed operational and accw-afe within regulatory requirements? <br /> Ycs 0 tie* Was the testing apparatus property calibrated? <br /> [ Yes ❑ No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> ❑ NIA <br /> ❑ Yes .0 No* For electronic LLDs,does the turbine automatically abut of}'if the LLD detects a leak? <br /> ® N/A <br /> ❑ Yes ❑ No* For electronic LJ..17s, does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> 0 NIA or discurmected? <br /> D Yes D No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions <br /> 0 VA or fails a test? <br /> 1❑ Yes O No* For electronic LLDs,have all acecssible wiring connections been visuslly inspected? <br /> ® NIA <br /> ® Yrs D No* Wen all items on the equipment manufacturer's maintenance checklist completed? <br /> *10 the Section FI,below;describe how and when these deficiencies were or will be corrected. <br /> H. Comments: The �swer�testeaou Z11.4I201atc�c:otxtpletexnorntodng�e�ti �cspecm�. <br /> Jett Wring on site _-- <br /> Page 3 of 4 <br /> t7d E9699V960Z wnelotled elge1le�:l eZ 6:90 t 1 LZ Inf <br />