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Muoitoring Systern Certification 1.0.4 <br /> Site Address: 2808 COUNTRY CLUB BLVD.. Date of Testing/Service: 02/18/2003 <br /> OFF 1-5 <br /> F. In-Tank Gauging l SIR Equipment El 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 /> ❑x Yes ❑No' Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> ❑x Yes ❑No' Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ❑x Yes ❑No' Was accuracy of system product level readings tested? <br /> ❑x Yes ❑No• Was accuracy of system water level readings tested? <br /> X yes ❑No• Were all probes reinstalled properly? <br /> ❑x Yes I ❑No• 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 /> 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' ❑N/A (Check all that apply)Simulated leak rate: Q 3 g.p.h❑0.1 g.p.h ❑0.2 g.p.h <br /> 1-1 Yes X No• Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> Fx_j Yes ❑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 /> Q ves ❑No• ❑MA For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> M 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 /> ❑x ves ❑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 /> Oyes ❑No' ❑N/A For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> Yes I❑No• 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 />