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Monitcring System Certification ' Site Address: _ Date ol" festing/Servicing: F. In -Tank Gauging /SIR Equipment: ❑ C,Iieck this box if tank gauging is used only for inventory control. /❑ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in -tank gauging equipment is used to perform 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 these deficiencies were or will be corrected G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. Complete the followinff checklist: ,O'Yes Cl No*LForuipment start-up or annual equipme�tfertification, was a leak simulated to verify LLD performance? ❑ N/Ak all that apply) Simulated leak rate: �] 3 g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. Yes ❑ No* ll LLDs confirmed operational and accurate within regulatory requirements? Pi>Ts ❑ No* Was the testing apparatus properly calibrated? yl Yes ❑ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ N/A ❑ Yes ❑ b* For electronic LLDs, does the turbine automatically shut-off if the LLD detects a leak? ° N/A ❑ Yes ❑ o* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled yj N'A u' uiscunnecteuf ❑ Yes ❑�lo* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system N/A malfunctions or fails a test? ❑ Yes ❑`,No* For electronic LLDs, have all accessible wiring connections been visually inspected? ,DC7 N/A ,ZYcs ^ No Were all items on the equipment manufacturer's maintenance rheCl{lict Completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: