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4 s VNDERGROUN_ STORAGE TANK MONITORING SYSTElva CERTIFICATION F. In -Tank Gauging / SIR Equipment: Permit Number: ❑ Check this box if tank gauging is used only for inventory control ❑ Check this box if no tank ga Laing or SIR equipment is installed This section must be completed if in -t - gauging equipment is used to perform leak detection monitoring, Comnlete the following checklist: ❑ Yes ❑ No* Has all input g been inspected for proper entry and termination, including testing for ground faults? ❑ Yes ❑ No* Were all tank gai6ing probes visually inspected for damage and residue buildup? ❑ Yes ❑ No* Was accuracy of s tem product level readings tested? ❑ Yes ❑ No* Was accuracy of syste water level readings tested? ❑ Yes ❑ No* Were all probes reinstalle roperly? ❑ Yes ❑ No* Were all items on the equipmen nufacturer's maintenance checklist completed? r in bection ti neiow, a, -,scribe now ana wizen these ae)dEaisb es were or will be corrected. G. Dine beak detectors ��): ❑Check t if LLDs are not installed. Comnlete the following checklist: ❑ Yes Cl No* For equipment start-up or annual equi ent certification, was a Leak simulated to verify LLD performance? CD NIA (Check all that apply) Simulated leak ate: ❑ 3 g.p.h.; ❑ 0.1 g.p.h. ; ❑ 0.2 g.p.h. ❑ Yes ❑ No* Were all LLDs confirmed oper 'onal and accurate within regulatoryzequirements? ❑ Yes ❑ No* Was the testing apparatus p perly calibrated? ❑ Yes ❑ No* For mechanical LLDs, d es the LLD restrict product flow if it detects a leak? ❑ N/A • I ❑ Yes ❑ No* For electronic LLDs, oes the turbine automatically shut off if the LLD detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LI.Ds does the turbine automatically shut off if any portion of the monitoring system is disabled ❑ N/A or disconnected? ❑ Yes ❑ No* For electronic LLDs,es the turbine automatically shut off if any portion of the monitoring system malfunctions ❑ NIA or fails a test? Yes C3 No* For electronic LLDs, have 1 accessible wiring connections been visually. inspected? Lcl--Y:e:s El NIA C]No* Were all items on the equipmen nufacturer's maintenance checklist completed? In Section1i below, -describe. -how and when these den`s ncies were or will be corrected. H. Comments: DEMMV9301,(Rev 08/02). Page 3 of 4 County of San Diego -DEH -Hazardous Materials Division.