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F. In-Tank Gauging/SIR Equipment: ® Check this box if tank gauging is used only for'inventorycontrol: <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 peifo m leak tectiommonitoring. <br /> Complete the following checklist: <br /> ❑ Yes ❑ No' Has all input wiring been inspected for proper ent y and ter nination,Including testing for ground Yaulis? <br /> ❑;Yes" ti Nd*l Were all tahli"pauprhg probes visually irfspected Y and residue buildup? <br /> ❑7 yea ;.L3 No •- Was accu -s tem, <br /> ' racy of ys product level readings - s <br /> ❑" Yes ❑ No' Was accuracy of system water level readings tes ? <br /> ❑�Yes ❑ No' Were all probes reinstalled properly? <br /> ❑.Yes ❑ No' Were all Items on the equipment manufacturer's r 4htenance checklist completed? <br /> In Section H,below,describe how and when these deficiencies were or will be co Tected. <br /> ine Leak Detectors(LLD): ❑ Check this t ox if LLD are not Installed. <br /> Complete efollowinm4achecklist: <br /> ®:_Yes ❑ No' .For aqulplfient startup or annual equipment i cation.was.a leak simulated to verify LLD performance? (Check all that appy)) <br /> ❑.. WA Sknulat d teak rate:.Z 3.g.p.h.; ❑0.1 g.p.h.; .E 10.2 g p•i. <br /> ® Yes .Nq tIFQa IkLlgs ccnfimped operational, aocurat thrfl ulatory rggultements7; <br /> ® Yes ❑ No' Was the testing apparatus property calibrated? <br /> ® Yes ❑ No'. For mechanical LLDS,does the LLD restrict prodt ct flow if i t detects a leak? <br /> ❑ N/A--,, <br /> ❑: Yes Q No' FtNeleclronk LLDs,does fire turbine automatical shut off If the LLD detects.a leak? <br /> ® WA. <br /> ❑.Yr3g ❑ No' Foratecitanie LLDs does the turbine automaticail shut off lif any portion of the monitoring system is disabled or disconnected? <br /> ® N/A <br /> Q'Yes ❑ No' For electronic LLD%does the turbine automaticali shut off if any portion ofthe monitoring system malfunctions.or We a test! <br /> ® WA <br /> ❑',Yes ❑ No' For electronic LLDs,have all accessible wiring c nections been visually inspected? <br /> ® N/A <br /> ❑ No' Were all items on the equipment manufacturer's aintenan x checklist completed? <br /> In Section H,below,describe how and when these deficiencies were or will be cor ected. <br /> H. Comments: LDS <br /> 81 120 3 22 28 PASS <br /> 91 100. 2 21 26 PASS <br /> DSL 130 3 22 12 PASS <br /> r <br /> _.� .zn <br /> Monitoring System Certification Page 3 f 4 JUL j 12014 2/21/07 <br /> ENVIRONMENTI AL HEALTH <br /> DEPARTMENT <br />