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UNDERGROUT ;TORAGE TANK MONITORING SYSTE. :ERTIFICATION <br /> F. In-Tank Gaugging/SIR Equipment: Permit Number: <br /> ❑ 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 ii in-tank gauging equipment is used to perform leak detection monitoring. <br /> Complete the following checklist: <br /> ❑ Yes ❑ No* I Has all input wiring been ins tied for proper entry and termination,including testing for ground faults? <br /> ❑ Yes ❑ No* Were all tank gauging prol3 s visually inspected for damage and residue buildup? <br /> ❑ Yes ❑ No* Was accuracy of systemProduct level readings tested? <br /> ❑ Yes I ❑ No* Was accuracy of system-eater level readings tested? <br /> ❑ Yes ❑ No* Were all probes reihstall6d properly? <br /> Cl Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist compieied? <br /> *In Section H below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors (LLD): ❑'Check this box if LLDs are not installed. <br /> Com Iete the following checklist: <br /> ❑ Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br /> ❑ NIA (Check all that apply) Simulated leak rate: ❑3 o,.p.,k1 ❑ 0.1 g.p.b- ; ❑ 0.2 g.p.h. <br /> ❑ Yes ❑ No* Were all LLDs confirmed operational and accurate within`rz gulatory requirements? <br /> ❑ Yes ❑ No* Was the testing apparatus properly calibrated? <br /> ❑ Yes ❑ No* For mechanical LLDs, does.the LLD restrict product flow if i detects a leak? <br /> ❑ N/A <br /> ❑ Yes ❑ No* For electronic LLDs,does the turbine automatically shut o if the LLD detects a leak? <br /> ED NIA <br /> ❑ Yes ❑ No* For electronic LLDs, does the turbine automaticall tit off if any portion of the monitoring system is disabled <br /> ❑ N/A or disconnected? <br /> ❑ Yes ❑ No* For electronic LLDs, does the turbine auto tally shut off if any portion of the monitoring system malfunctions <br /> ❑ NIA or fails a test? <br /> ❑ Yes ❑ No* For electronic LLDs,have all accessi e wiring connections been visually.inspected? <br /> ED NIA <br /> ❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> *In Section H below,-describe-how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> DEMBM-9301.(Rev 08/02). Page 3 of 4 County of San Diego-DEH-Hazardous Materials Division <br />