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�GHTMI-RrAN live: GR Job# 20-640046 <br /> F. In-Tank Gauging/SIR Equipment: ❑ 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 rf in-tank gauging equipment is used to perform leak detection monitoring. <br /> Complete the to4lowAing checklist <br /> ryes 13o Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> E Yes ❑ No' Were all tank gauging probes visually inspected for damage and residue buildup? <br /> E Yes ❑ No* Was accuracy of system products level readings tested? <br /> Id Yes ❑ No' Was accuracy of system water level readings tested? <br /> (I Yes ❑ No* Were all probes reinstalled property? <br /> Yes 1 ❑ No' lWere all items on the equipment manufacturer's maintenance checklist cornpieted? T <br /> n s on low, ow when thesedeficiencies were or correct <br /> G. Line Leak Detectors(LLD): ❑ Check this box if LLDs are not installed. <br /> Complete the followin checklist: <br /> r Yes ❑ o or equipment start-up or annual equipment certincation,was a leak ssmulatea to verity performance?(check <br /> (3 N/A that apply) Simulated leak rate: ® 3 g.p.h. ❑ 0.1 g.p.h. ❑ 0.2 g.p.h. <br /> [j Yes ❑ No' Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> UL Yes ❑ No' Was the testing apparatus properly calibrated? <br /> ❑ Yes ❑ No' For Mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> G N/A <br /> Yes ❑ No' For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ❑ N/A <br /> 11 Yes ❑ No' For electronic LLDs,does the turbine�automatically shut off if any portion of the monitoring system is disabled or <br /> ❑ N/A Disconnected? <br /> Yes ❑ No' For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or <br /> ❑ WA Ifails a test? <br /> U Yes ❑ No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> ❑ WA <br /> [L- Yes ❑ No' 1were all items on the equipment manufacturers maintenance checklist completed? <br /> In the Section H,below,describe and when these d#ficlencles were—orwi-11 be corrected. <br /> G. Comments: <br /> Monitoring System Certllfication Page 3 of 4 12107 <br /> 3 <br />