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F. In -Tank Gauging I 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. g <br />Complete the followina checklist: 3 <br />_i Yes <br />No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />❑ Yes <br />❑ No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />Yes <br />F] No* <br />Was accuracy of system product level readings tested? <br />Yes <br />I No* <br />Was accuracy of system water level readings tested? <br />❑ Yes <br />❑ No* <br />Were all probes reinstalled properly? <br />Yes <br />No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />- in the section n, Deiow, aescriDe now ana when tnese aeficienaes were or will be corrected. <br />G. Line Leak Detectors (LLD): i Check this box if LLDs are not installed. <br />Complete the followina checklist: <br />® <br />Yes <br />No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all <br />N/A <br />that apply) Simulated leak rate: ® 3 g.p.h., 0.1 g.p.h ; 0.2 g.p.h. <br />® <br />Yes <br />7 <br />No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />® <br />Yes <br />❑ <br />No* <br />Was the testing apparatus properly calibrated? <br />® <br />Yes <br />❑ <br />No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ <br />N/A <br />L <br />Yes <br />❑ <br />No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />® <br />N/A <br />❑ <br />Yes <br />❑ <br />No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or <br />I@ <br />N/A <br />disconnected? <br />C <br />Yes <br />,-i <br />No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or <br />® <br />N/A <br />fails a test? <br />Yes <br />No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />® <br />N/A <br />® <br />Yes <br />❑ <br />No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />• In the Section H, below, describe how and when these deficiencies were or will be corrected. <br />H. Comments: <br />Monitoring System Certification Page 3 of 4 12/07 <br />3 2/21/07 <br />