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Miss <br />U, 6f ffLfR-RYAN <br />"GR Job # 20-643211 <br />F. In -Tank Gauging / SIR Equipment: 12, 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 />Comolete the followina checklist <br />❑ <br />Yes <br />❑ <br />o <br />Has all input wing been inspected for proper entry and termination, including testing for grou ' <br />❑ <br />Yes <br />❑ <br />No' <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />❑ <br />Yes <br />❑ <br />No' <br />Was accuracy of system products level readings tested? <br />❑ <br />Yes <br />❑ <br />Ni <br />Was accuracy of system water level readings tested? <br />❑ <br />Yes <br />❑ <br />Ni <br />Were all probes reinstalled property? <br />❑ <br />Yes <br />❑ <br />No' <br />Were all items on the equipment manufacturers maintenance checklist completed? <br />G. Line Leak Detectors (LLD): <br />Comolete the followina cheokllet <br />V <br />1efficiencies were or will be corrected. ENVIRON,Vi- + <br />.. , . . -1 11. ! H <br />L'VV <br />t1 '�l - <br />R Check this box 0 LLDs are not installed. DEPARTMENT <br />❑ <br />es <br />❑ <br />(ZN/A <br />o <br />or egwpmen start-up or annus equipmen cewon, was a ea simu a e o ver pe oonance. c ec a <br />that app/y) Simulated leak rate: ❑ 3g.p.h. ❑ 0.1 g.p.h. ❑0.2 g.p.h. <br />❑ <br />Yes <br />❑ <br />No' <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />❑ <br />Yes <br />❑ <br />No' <br />Was the testing apparatus property calibrated? <br />❑ <br />Yes <br />❑ <br />No' <br />NIA <br />For Mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ <br />Yes <br />❑ <br />ry <br />No' <br />NIA <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />❑ <br />Yes <br />❑ <br />E <br />No' <br />NIA <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or <br />Disconnected? <br />❑ <br />Yes <br />❑ <br />ry <br />No- <br />N/A 1fails <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or <br />a test? <br />❑ <br />Yes <br />❑ <br />No' <br />N/A <br />For electronic LLDs, have all accessible wiring connectors been visually inspected? <br />❑ <br />Yes 1 <br />❑ <br />No' 1were <br />all items on the equipment manufacturers maintenance checklist completed? <br />In the <br />Section <br />H. below_ <br />descrilas hmiv and when them dpflrupnrlps wpro nr vnu ho rn.rn.tp <br />G. Comments: <br />Monitoring System Certification <br />Page 3 of 4 <br />3 <br />1210? <br />