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r <br /> UNDERGROUND STORAGE T Ahs MONITORING SYSTEin CERTIFICATION <br /> F. In-Tank Gauging/SIR Equipment: # permit-Number: <br /> TMN ❑ Check this box if tank gauging is used only for inventory control <br /> ❑ Check this box if no tank aauZins,or SIR �pment ;installed <br /> This section must be completed if in- ' gauging equipment is used to perform leak detection monitoring. <br /> Complete the following checklist: <br /> ❑ Yes ❑ No* Has all input wiring been ins .-ted for proper entry and termination,including testing for ground faults? <br /> ❑ Yes ❑ No* Were all tank gauging probes ViNally inspected for damage and residue buildup? <br /> ❑ Yes ❑ No* Was accuracy of system product le el readings tested? <br /> ❑ Yes ❑ No* Was accuracy of system water level eadings tested? <br /> ❑ Yes ❑ No* Were all probes reinstalled properly <br /> ❑ Yes ❑ No* Were all items on the equipment ufacturer's maintenance checklist completed? <br /> *In Section H below,describe how and when these efficiencies were or will be corrected. <br /> G. Line Leak Detectors (LLD): ❑' ck this box if LLDs are not installed. <br /> Complete the following checklist: <br /> ❑ Yes ❑ No* For equipment start-upoz ual equipment certification, was a leak simulated to verify LLD performance? <br /> ❑ N/A (Check all that apply) S' ated leak rate: ❑3 g.p.h.; ❑ 0.1 g.p.h. ; ❑ 0.2 g.p.h. <br /> ❑ Yes ❑ No* Were all LLDs confirme operational and accurate within regulatory requirements? <br /> ❑ Yes ❑ No* Was the testing apparatus properly calibrated? <br /> ❑ Yes ❑ No* For mechanical LLDs,do s the LLD restrict product flow if it detects a leak? <br /> ❑ NIA <br /> ❑ Yes ❑ No* For electronic LLDs,does a turbine automatically shut off if the LLD detects a leak? <br /> ❑ NIA <br /> ❑ Yes ❑ No* For electronic LLDs, does the\turbine automatically shut off if any portion of the monitoring system is disabled <br /> ❑ N/A or disconnected? <br /> ❑ Yes ❑ No* For electronic LLDs, does the tur]31�e automatically shut off if any portion of the monitoring system malfunctions <br /> ❑ NIA or fails a test? \ <br /> ❑ Yes ❑ No* For electronic LLDs,have all access i a wiring connections been visually.inspected? <br /> ❑ 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 /> r <br /> DEMI3M-9301,(Rev 08/02) Page 3 of 4 County of San Diego-DEH-Hazardous Materials Division <br />