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f , <br /> t# J <br /> Monitoring System Certification <br /> r' F. In-Tank Gauging/SIR Equipment: x 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 termircatinn,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 property? <br /> x Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> * In the Section H,below,describe how and when them deficiencies were or will be corrected. <br /> G. Line leak Detectors (LLD): ❑ Check this box if LLDs are not installed. <br /> Com lete the following checklist: <br /> X Yes ❑ No" For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br /> ❑ NIA (Check all that apply) Simulated teak rate: x 3 g.p.h.; ❑0.1 g.p.h: [10.2 g.p.h. <br /> x Yes ❑ No" Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> x Yes ❑ No* Was the testing apparatus properly calibrated? <br /> x Yes ❑ No* For mechanical LUX does the LID restrict product flow if it detects a Teak? <br /> ❑ N/A <br /> ❑ Yes ❑ No* For electronic I.LDs,does the turbine automatically shut off if the LLD detects a leak? <br /> X N/A <br /> ❑ No' For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> Cd yes <br /> X N/A or disconnected? <br /> ❑ Yes p No' For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions <br /> x N/A or fails a test? <br /> p Yes ❑ No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> X N/A <br /> x Yes ❑ Nn' Were all items on the equipment manufacturer's 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 /> UN-036-1/4 www.anitlm+s.org Rev.0126/06 <br />