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From: Franzen -Hill Inc. To: 12094683433 Page: 5/5 Date: 1/20/2011 4:54:21 PM <br />F. in -Tanis Gauging / SIR Equipment: E Check this box if tank gauging is used only for inventory control, <br />E 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 perfo= leak detection monitoring. <br />%:omplew ule lullwrmu w.v.:n..a.. <br />E Yes E Na" Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />E <br />Yes <br />E <br />No" <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />E <br />Yes <br />E <br />No" <br />Was accuracy of system product level readings tested? <br />E <br />Yes <br />E <br />No" <br />Was accuracy of system water level readings tested? <br />E <br />Yes <br />E <br />No' <br />Were all probes reinstalled properly? <br />E <br />Yes <br />E <br />NO* <br />Were all items on the equipment manufacturer's maintenance check/ completed? <br />" In me Section in, Derow, aesumm nuw all" Wily.. Ff IVAA vc..w.v..wvv <br />G. Line Leak Detectors (LLD): E Check this box if LLD$ are not installed. <br />j':om <br />E 'e <br />711@ Tullumpalle w.v.sn..aa. <br />E Ne <br />For equipment start-up or annual eqqjppWAt certill on, was a leak simulated to verify LLD performance? (Check all <br />E <br />NIA <br />that apply) Simulated leak rate: E g.p. E 0.1 g.p.h ; E 0.2 g.p.h. <br />E ape <br />E <br />No" <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />F.. eNqg <br />E <br />No" <br />Was the testing apparatus properly calibrated? <br />E e <br />E <br />No" <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />E <br />NtA <br />NtA <br />B Yes <br />i7 <br />tom <br />For electronic LLDs, does the turbine auatically shut off if the LLD detects a leak? <br />E Yes <br />E <br />E <br />(MW <br />N* <br />For electronic LLDs, does the turbine automatically shutoff If any portion of the monitoring system is disabled <br />E <br />or <br />E Yes <br />E <br />No' <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system matfunctions or <br />F, <br />OAD <br />fails a test? <br />F Yes <br />E <br />For electronic LLDs, have all sooessible wiring connections been visually Inspected? <br />E <br />E es <br />E <br />No" <br />Were all Items an the equipment manufacturer's maintenance checklist completed? <br />-vaAne secuon n, Deluwl aesu"U" IMM 421111 Wilv.. 11.vav a.v,.v.v..v.vv <br />H. Comments: <br />Monitoring System Certification Page 3 of 4 12107 <br />3 2121/47 <br />This fax was sent with GFI FAXmaker fax server. For more information, visit: http://www.gfi.com <br />