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iv onitcring System Certification Site Address: 71,1 ri 1� �2 -� Ely ? a Date orTesting/Servicing: Ij F. In -Tank Gauging / SIR Equipment: C�1'Check this box if tank gau(ling is used only for inventory control. ❑ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in -tank gaufling equipment is used to perform leaf: detection monitoring. Comnlete the following checklist: ❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? ❑ Yes ❑ No* Was accuracy of system product level readings tested? ❑ Yes ❑ No* Was accuracy of system water level readings tested? ❑ Yes ❑ No* Were all probes reinstalled properly? ❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. Comnlete the following checklist: Yes ❑ No* For equipment start-up or annual equipment ceer fication, was a leak simulated to verify LLD performance? ❑ N/A (Check all that appl)) Simulated leak rate: El3 g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. ❑ Ye No* Were all LLDs confirmed operational and accurate within regulatory requirements? Yes ❑ No* Was the testing apparatus properly calibrated? ❑ Yes ElNo* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ N/A ❑ Yes ❑l For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? �Na* ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled U--N'/A or disconnected? ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system Ur/N/A malfunctions or fails a test? ❑ Yes ❑NN For electronic LLDs, have all accessible wiring connections been visually inspected? Cd" N/A ET�Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, descrioe now and when tnese oenciencies were or win oe correcteu. H. Comments: C Page 3 of 3 05/00