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•onitoring System Certification <br /> Site Address: 470 N MAIN ST Date of Testing/Service: 12/12/2002 <br /> F. In-Tank Gauging I 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 perform leak detection monitoring. <br /> Complete the following checklist: <br /> ®Yes FINo• Has all input wiring been inspected for proper entry and termination,including 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 readings tested? <br /> ®Yes ❑No• Was accuracy of system water level readings tested? <br /> Yes ❑No' Were all probes reinstalled properly? <br /> ®Yes No• Were all items on the equipment manufacturers'maintenance checklist completed? <br /> •In the Section H,below,describe now and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors (LLD) : ❑ Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> For equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance? <br /> ®Yes ❑No• Q N/A (Check all that apply)Simulated leak rate: [fl 3 g.p.h❑0.1 g.p.h E]0.2 g.p.h <br /> Yes ❑No Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> Yes ❑No' Was the testing apparatus properly calibrated? <br /> ®Yes El No• ❑N/A For mechanical LLDs,does the LLD restrict product Flow if it detects a leak? <br /> shut off if the LLD detects a leak? <br /> Yes ONo• ©N/A For electronic LLDs,does the turbine automatically <br /> • ® shut off if any portion of the monitoring system is disabled or disconnected? <br /> Yes ONO N/A For electronic LLDs,does the turbine automatically <br /> Yes ONO- ®N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> ❑ <br /> Yes 0No• ®N/A For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> M Yes F—INo• Were all items on the equipment manufacturers'maintenance checklist completed? <br /> •In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> page 3 of 3 <br />