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• Aug. 6, 2018 9: 30AM Donlee Pump Co No, 0377 P. 4 <br /> Monitoring System Certification 0 0 <br /> F. In-Tank Gauging/SIR Equipment: W Check this box if tank gauging is used only for inventory control. <br /> [I 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 /> Complete the following checklist.- <br /> -6—yea 0 No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> ❑ 'Yes 0 No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> 0 Yes U No* IA <br /> Was—accuracy of system product level readings tested? <br /> 0 Yes 0 No* Was accuracy of system water level readings tested? —71 7C__M6_ <br /> [3 Ye 0 NO Were 4 probes reinstalled properly? <br /> Yes [] Now Were all items on the equipment manufacturer's maintenance checklist completed? E N V I RY,�,M E N TA L <br /> 7� , !I ENT <br /> HEN H V,"FRI ff�,fir <br /> In Section H,below,describe how and when these defleiencies were or will be corrected. <br /> G. Line Leak Detectors (LLD): [3 Check this box if LLDs are not installed. <br /> Com tete the follorviniz checklist: — <br /> 9 Yes [3 NO For equipment start-up or annual equipment certification, was a leak simulated to verify Ul) performance? <br /> [3 N/A (Check all that apply) Simulated leak rate: 99 3 g.p.h,; [3 0.1 g.p.h; [10.2 g.p.h- <br /> ja yes [I No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> Yes U No* Was the testing apparatus properly calibrated? <br /> Iff Y 0 No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> 0 N/A <br /> [j yes (j * For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> 0 NIA <br /> 0 yes [3 No* for electronic W)s,does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> 4 NIA or disconnected? <br /> 0 Yes 0 No* for—electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions <br /> g N/A 1 Or fails 8 test? <br /> 0 Yes C] No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> { -NIA <br /> Yes 0 No' Were all Stems 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 /> Page - 3 of 4 <br /> TJN-036—516 www.unldomorg Rev.01117/08 <br />