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im6ErrLE9-RYAN INC. GR Job# 1720- 4467 <br /> S WRCB,January 2006 <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 if in-tank gauging equipment is used to perform leak detection monitoring. <br /> Complete the following checkliat <br /> Yes ❑ o I Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> .FIYes ❑ No' Were all tank gauging probes visually Inspected for damage and residue buildup? <br /> Yes ❑ No* Was accuracy of system products level readings tested? <br /> ® Yes ❑ No' Was accuracy of system water level readings tested? <br /> ❑ es ❑ No' Were all probes reinstalled properly? <br /> Yes ❑ No' Were all items on the equipment manufacturers maintenance checklist completed? <br /> In the Section , e ow, esc ow an en ese e c enc es were or will be corrected. <br /> G. Line Leak Detectors(LLD): ❑ Check this box if LLDs are not installed. <br /> Complete the following checklist <br /> ❑ es ❑ o or equipment start-up or annua7e—quipment certirficabon,was a leak simulated verity performance?(check ali <br /> ❑ N/A thatapp/y) Simulated leak rate: 0 3 g.p.h. [] 0.1 g.p.h. ❑ 0.2 g.p.h. <br /> 0 Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> 0 Yes ❑ No* Was the testing apparatus properly calibrated? <br /> ❑ Yes ❑ No* For Mechanical LLDs,does the LLD restrict product flow 0 h detects a leak? <br /> 0 N/A <br /> Yes ❑ No' For electronic LLDs,does the turbine automatically shut off I the LLD detects a leak? <br /> (� N/A <br /> 0 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 /> 0 Yes ❑ No• For electronic LLDs,does the turbine automatically shut off rf any portion of the monitoring system malfunctions or <br /> ❑ N/A fails a test? <br /> 0 Yes ❑ No' For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> ❑ N/A <br /> 0 Yes I ❑ No* were all items on the equipment manufacturers maintenance checklist completed? <br /> In the Section H,below,describe how and when these deficlenclee were or will be corrected. <br /> G. Comments: <br /> Monitoring System Certification Page 3 of 4 12107 <br /> 3 <br />