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Dec 10 03 09:43a p.3 <br />M anitcri ng System Certificate <br />le <br />Sil a Addr :ss: <br />F. In -lank Gauging/ SIR Equipment: <br />Date of Testing/Servicing: 1/ /6-7 G--3 <br />Q- heck this box if tank gauging is used only for inventory control. <br />O Check this box if no tank gauging or SIR equipment is installed. <br />TT is sec tion must be completed if in -tank gauging equipment is used to perform leak detection monitoring <br />Complete the following checklist: <br />Yes 13 No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />❑ Yes ❑ No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />❑ Yes 13 No* <br />Was accuracy of system product level readings tested? <br />1O <br />❑ Yes ' ❑ <br />system water Was accuracy of systewater level readings tested? <br />❑ Yes 3 "No* <br />Were all probes reinstalled property? <br />❑ t'es ❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* It the S<etion H, <br />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 />Cort to , he foliowiog checklist: <br />"es 1j No* <br />I ] N/A <br />For equipment start-up or annual equipment ce�ation, was a teak simulated to verify LLD perform <br />(Check <br />all that apply) Simulated leak rate:3C3" g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. <br />11 Yes Q No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />41:os 11 No* <br />Was the testing apparatus properly calibrated? <br />1'es 11 No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />I it N/A <br />❑ N es Ell,N.-�-* <br />C � N/A <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />❑ Yes CI�NP* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disg <br />I <br />I N/A or disconnected? <br />5—y F. No's For electronic LLDs, does the turbine automatically shut off if <br />N/A malfunctions or fails a test? <br />5-y- �I p* For electronic LLDs, have all accessible wiring connections been visua <br />N/A <br />!.7 Y No* Were all items on the equipment manufacturer's maintenance checklist <br />" In i he Sec fon H, below, describe how and when these deficiencies were or will be corn <br />H. Comments: <br />ance? <br />any portion of the monitoring system <br />Page 3 of 3 05100 1 <br />