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Moniferi.ng System Certification <br /> Site Address: <br /> Date of Testing/Servicing: <br /> F. In-Tank Gauging/SIR Equipment: heck this box if tank gauging is used only for inventory'controi. <br /> ❑ Check this box if no tank gain Bii <br /> ® L ng or SIR equipment is installed. <br /> This section trust be completed if in-tank gauging equipment is used to perform leak detection monitoring. <br /> Complete the following checklist: <br /> Yes ❑ No*F14a input wiring been inspected for proper entry and termination, including testing for ground faults? <br /> Yes ❑ No* ll tank gauging probes visually inspected for damage and residue buildup? <br /> Yes ❑ No* curacy of system product level readings tested? <br /> Yes ❑ No* curacy of system water level readings tested? <br /> es ❑ �No* ll probes reinstalled properly? __j <br /> Yes I ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> * <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 ❑ No* For equipment start-up or annual equipment citrtification, was a leak simulated to verify LLD ddisabled <br /> ❑ N/A (Check all that apply) Simulated leak rate: 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 /> Y s ❑ No* Was the testing apparatus properly calibrated? <br /> Yes ❑ No* Foe mechanical LLDs,does the LLD restrict productflow if it detects a leak? <br /> ❑ N/A <br /> ❑ Yes �❑ 14o* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br /> Q N/A <br /> ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring syste0"N/A or disconnected? <br /> � Yes ❑ No* For electronic LLDs, does (lie turbine automatically shut off if any portion of the monito <br /> .OWN/A malfunctions or fails a test? <br /> 3 Yes ❑ o* For electronic LLDs, have all accessible wiring connections been visually inspected? <br /> i N/A <br /> Yes ❑ No* 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 /> I. Comments: <br />