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9255517888 Line 1 • 42:21 07-19-2012 4/5 <br /> ®6F7TLeit-RYAN INC. GR Job# 20-581614 <br /> F. In-Tank Gauging/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 cheakifst <br /> 11—yes <br /> 0 o Has aliinput widng been inspected for proper entry and termination,including testing for ground faults? <br /> ❑ No' Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ❑ No' Was accuracy of system products level readings tested? <br /> ❑ W Wasacwmcy of system water level readings tested? <br /> ❑ No` Were all probes reinstalled properW <br /> 11 ❑ No` Were all items m the equipment manufacturers maintenance checklist completed? <br /> H, elaw,ousumbe now and men these deficiencies were or will be coffee e . <br /> G. Line Leak Detectors(LLD): [I Check this box it LLDs are not Installed. <br /> Complete the following checklist: <br /> P❑ es E] o For equ pment start-up or annual equipment ten icatbn,was a ea simu ated to vert LD perfarmande7 check all <br /> ❑ N/A that appy)Simulated leak rate: ❑ 3 g.p.h. ❑ 0.1 g.p.h. ❑ 0.2 g.p.h. <br /> ❑ Yes ❑ No' Were all LLDs corfirmad operational and accurate within regulatory requirements? <br /> ❑ Yes ❑ No' Was the testing apparatus properly calibrated? <br /> ❑ Yes ❑ No` For Mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> 13 N/A <br /> ❑ Yes ❑ No" For electronic LLOs,does the turbine automatically shut off if the LLD detects a leak? <br /> ❑ WA <br /> L13 Yes [INo` or electronic LLDs,does the turbine automatically shut off any portion of themonitoringsystemIs❑ NIA Dlaconnected? <br /> Yes [3No- For electronic LLDs,does the turbine automatically shut off k any ponlon ofihe mongodng system malfunctions or <br /> 1) NIA fails a test? <br /> Yes [3No` For electronic LLDs, eve all accessible ring connections been visually Inspected? <br /> ❑ NIA <br /> Yes ❑ No' were all Items on the equipment manufacturers maintenance checklist completed? <br /> `i n me Se on 11,below.describe how and when these deficiencies were or will Fe cam <br /> G. .. Comments: <br /> Monitoring System Certification Page 3 of 12/07 <br /> 3 <br />