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EQUYED <br /> F. In-Tank Gauging/SIR Equipment: ® Check this box ff tank gauging is use ony for inventory control. <br /> ❑ Check this box rf 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. .IUL .112 <br /> Complete the following checklist: H <br /> ❑ Yes ❑ No' Has all input wining been inspected for proper entry and termination,including testing for groug O fl <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 property? <br /> ❑ Yes ❑ No' Were all items on the equipment manufacturers maintenance checklist completed? <br /> •In Section H,below,describe how and when these deficiencies were or will be corrected. <br /> Line Leak Detectors(LLD(: (3 Check this box N LLDs are not installed. <br /> Com late the followin 1 checklist: <br /> ® Yes ❑ No' For equipment start-up or annual equipment certification, was a leak simulatEverifyLD performance? (Check all hat appy)N/A Simulated leak rate: ®3 g.p.h.; ❑0.1 g.p.h; ❑0.2 g.p.h. <br /> Yes ❑ No' Were all LLDs confirmed operational and accurate within regulatory requirementsYes ❑ No' Was the testing apparatus properly calibrated? <br /> Yes ❑ No' For mechanical LLDs,does the LLD restrct product flow If it detects a leak?N/A <br /> Yes ❑ No' For electronic LLDs,does the turbine automatically shut off g the LLD detects a l <br /> ® N/A <br /> ❑ Yes ❑ No' For electronic LLDs,does the turbine automatically shut off ff any portion of the monitoring system is disabled or disconnected? <br /> ® N/A <br /> ❑ Yes ❑ No' For electronic LLDs,does the turbine automatically shut off'f any portion of the monitoring system malfunctions or(ails a test? <br /> ® N/A <br /> ❑ Yes ❑ No' For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> ® N/A <br /> ® Yes ❑ No' Were all items on the equipment manufacturers maintenance checklist completed? <br /> •In Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. comments: Leak Detectors: <br /> 87 2 100 25 21 PASS <br /> 91 150 3 24 12 PASS <br /> Monitoring System Certification <br /> Page 3 of 4 2/21/07 <br />