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12/30/2010 14:15 5307499892 <br /> MIDVALLEY CONSULTING PAGE 05 <br /> `/ `/ <br /> F. In-Tank Gauging/SIR Equipment Check x this box it eck this box it no tank gauging nk gauging Is Of Stor <br /> egu rpment is installed.•. <br /> This aeeion must be completed if in-tank gauging oquiprrwnt is used to perform leak detection monitoring. <br /> the fel(pwi cctrecklls[: - — <br /> ❑ Yes 0 Nom Has all input w&g been for proper entry and termination,inGuding testing for ground fautts7 <br /> tl Yes C No' Were all tank gauging probes visually inspected for damage and resklue buildup? <br /> ❑ Yes U No' Was accuracy of system prodrxt level readings tested? <br /> 3 Yes r W. Was accumcy of system water level readings tested? <br /> ❑ Yes C No' Were all probes reinstalled properly? <br /> C Yes ❑ NO' Were a I items on the equipment manufacturers maintenance cWAllst completed? <br /> in the cdon H,below,descnba how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors(LLD): Check this box If LLDs are not installed. <br /> cum Tete the tollowin checklist: <br /> X es NO For equiprnent start-up or annual equipment rartifiration,Was a leak simulated to vergy LLD perf6nnarrce7(Check aU <br /> G WA that aoW) Simulated leak rate: 7 3 g.p.h.; ❑0.1 g.p.h; C 0.2 g.p.h. <br /> X Yea D No" Were all LI.As conUreredaperatlonal and accurate within regulatory requkements? <br /> X Yes —0--N-07--- Was the testing apparatus properly calibrated? <br /> C Yes -'E---NQ For mechanical LLbs,does the LLD restrkt product flow if d detect a leak? <br /> X WA <br /> x Yes C No' For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> WA <br /> x Yes G No' For electronic LLD$, does the turbine automatically shut off g any portion of the rronAonng system m disabled or <br /> WA disconnected? <br /> x Yes ❑ No' For electronic LLDs, does the turbine automatically shut off 4 any portion of the monitoring system melhlnrtions or <br /> WA falls a test? <br /> X Yes ❑ No. For electronic 61..0s,have ah accessible wiring Connections been visually inspected? <br /> 3 WA <br /> X Yes C No' were as items on the equipment manufacturers maintenance checklist completed? <br /> In the Section H,below,describe how and wtwn these deficiencies were er will be corrected. <br /> H. Comments: <br /> Monitoring System Certification Page 3 of 4 74107 <br /> 3 2/21/07 <br />