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9255517888 Line 1 <br />a <br />GETTLER-RYAN INC. <br />4:25:36 09-25-2014 4/16 <br />is GR Joh # 10-062098.1 <br />F. In -Tank Gauging / SIR Equipment: Cx Check this box if tank gauging is used only for inventory control. <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 perform leak detection monitoring. <br />PPrComolete the followina checklist! ._ <br />IR <br />es <br />® <br />o <br />Has all Input wiring been inspected for proper entry and termination, Including testing for ground faults? <br />E <br />Yes <br />❑ <br />No' <br />Were all tank gauging probes visually inspected for damage and residue buildup? 2,014 <br />E <br />Yes <br />❑ <br />No' <br />Was accuracy of system products level readings tested? <br />E <br />Yes <br />❑ <br />No. <br />Was accuracy of system water level readings tested? <br />❑ <br />Yes <br />❑ <br />No' <br />Were all probes reinstalled properly? <br />Yes <br />❑ <br />No• <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />in the aecaon n, oeiow, oescnoe now ano wnen these aettciencies were or will be corrected. <br />G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. <br />Comolete the followina checklist: <br />ji <br />Yes <br />❑-No--For <br />equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (check all <br />❑ <br />N/A <br />that apply) Simulated leak rate: W 3 g.p.h. ❑ 0.1 g.p-h- ❑ 0.2 g.p.h. <br />[I <br />Yes <br />❑ <br />No' <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />rg <br />Yes <br />❑ <br />No' <br />Was the testing apparatus properly calibrated? <br />❑ <br />Yes <br />❑ <br />No' <br />For Mechanical LLDs, does the LLD restrict product flow if It detects a leak? <br />rg <br />N/A <br />E <br />Yes <br />❑ <br />No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />❑ <br />N/A <br />Yes <br />❑ <br />No' <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or <br />❑ <br />N/A <br />Disconnected? <br />Yes <br />❑ <br />No" <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or <br />❑ <br />N/A <br />fails a test? <br />Yes <br />❑ <br />No" <br />For electronic LLDs, have all accessible wiring connections been visually inspected? ' <br />❑ <br />N/A <br />rg Yes ® No' <br />were all items on the equipment manufacturer's maintenance checklist completed? <br />... ...—-----.. • •, ---e.., .. �..—..— .............+ ........ •....aa. Ywee..eaee..ew ..ce V Ye aveV Y6 YVI IGYI�{A. <br />G. Comments: <br />Monitoring System Certification Page 3 of 4 <br />3 <br />Received Time Sep.25. 2014 2:16PM No.7150 <br />12!07 <br />