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N GwLER-RYAN INN. GR Job # 20-632266 F. In -Tank Gauging / SIR Equipment rA Check this box if tank gauging is used only for inventory control. ❑ Check this box if no tank gauging or SIR equipm This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. RECEJ E L Complete the following checklist: w 4 III .v1 `', III ole OWAlun n, UeIUW, Uescnue now allu Wnen Ulese Uellulencles were Ur Will ue correlaeu. G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. Complete the followino checklist: e5 ❑ o Has all input wiring been inspected for proper entry and termination, including testing for ground faults? Yes ❑ No` Were all tank gauging probes visually inspected for damage and residue buildup? E Yes ❑ No' Was accuracy of system products level readings tested? E Yes ❑ No' Was accuracy of system water level readings tested? ry Yes ❑ No' Were all probes reinstalled properly? Yes 1❑ No' Were all items on the equipment manufacturer's maintenance checklist completed? III ole OWAlun n, UeIUW, Uescnue now allu Wnen Ulese Uellulencles were Ur Will ue correlaeu. G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. Complete the followino checklist: In LIIC AecUUn n, UBWw, uescnue now anu wnen Ulese Uenclencles were ur will Lie cUrre6leu. G. Comments: Monitoring System Certification Page 3 of 4 12107 Q Yes ❑ o or equipment start-up or annual equipment certification, was a leak simulated to verify LL13 pe ormance (check all ® N/A that apply) Simulated leak rate: ® 3 g.p.h. ❑ 0.1 g.p.h. ❑ 0.2 g.p.h. Yes ❑ No' Were all LLDs confirmed operational and accurate within regulatory requirements? FA Yes ❑ No' Was the testing apparatus properly calibrated? ❑ Yes ® No' For Mechanical LLDs, does the LLD restrict product flow if it detects a leak? NIA [Z Yes ❑ No` For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑ N/A Yes ❑ No' For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or ® N/A Disconnected? rA Yes ❑ No" For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or ❑ N/A fails a is E Yes ® No' For electronic LLDs, have all accessible wiring connections been visually inspected? ❑ N/A Yes 1 ❑ No' were all items on the equipment manufacturer's maintenance checklist completed? In LIIC AecUUn n, UBWw, uescnue now anu wnen Ulese Uenclencles were ur will Lie cUrre6leu. G. Comments: Monitoring System Certification Page 3 of 4 12107 Q