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Moniler*rgSystem Certification Site Address: Date of'festing/Servicing: F. In-Tank Gauging/SIREquipment: ❑ Check this box if tank gauging is used only for inventory control. ❑'Clreck this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perforin leak detection monitoring. Complete 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 tl_ese deficiencies were or wiii be corrected. G. Line Leak Detectors (LLD): &.1-c—Ileck this box if LLDs are not installed. Complete the following checklist: ❑ Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLDdsystem ❑ N/A (Check all that apply) Simulated leak rate: ❑ 3 g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. ❑ Yes Cl No* Were all LLDs confirmed operational and accurate within regulatory requirements? ❑ Yes ❑ No* Was tl�e testing apparatus properly calibrated? ❑ Yes ❑ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ N/A O Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring syste ❑ N/A or disconnected? 7 Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monito ❑ N/A malfunctions or fails a test? Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? ❑ N/A ] 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. L Comments: