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6EMIR-RYAN INC. GR .Job # 20-630008 <br /> F. In-Tank Gauging/SIR Equipment: G Check this box if tank gauging is used only for inventory control. <br /> ❑ Check this box if no tank gauging or SIR equipment is,t:install d... <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. IVEL) <br /> ; - L <br /> Complete the following checklist: <br /> Yes ❑ o Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> Iy Yes No' Were all tank gauging probes visually inspected for damage and residue buildup? ENTAL. <br /> Yes ❑ No' Was accuracy of system products level readings tested? <br /> argrT <br /> F& Yes ❑ No' Was accuracy of system water level readings tested? ' <br /> E Yes ❑ No' Were all probes reinstalled properly? <br /> a Yes ❑ No' 1were 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 /> G. Line Leak Detectors(LLD): ❑ Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> Yes ❑ o For equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance?(check all <br /> ❑ N/A that apply) Simulated leak rate: ® 3 g.p.h. ❑ 0.1 g.p.h. ❑ 0.2 g.p.h. <br /> Yes ❑ No' Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> Yes ❑ No' Was the testing apparatus properly calibrated? <br /> ❑ Yes ❑ No' For Mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> N/A <br /> Yes ❑ No' For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ❑ N/A <br /> Yes ❑ No' For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or <br /> ❑ N/A Disconnected? <br /> �y Yes ❑ No' For electronic LLDs,does the turbine automatically shut off rf any portion of the monitoring system malfunctions or <br /> ❑ N/A fails a test? <br /> Yes ❑ No' For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> ❑ N/A <br /> Yes I ❑ No' 1were 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 /> G. Comments: <br /> Monitoring System Certification Page 3 of 4 12/07 <br />