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N."ronitoring System Certification 0 <br />Site Address: 4344 WATERLOO RD Date of Testing/Service: 03/26/2001 <br />F. In -Tank Gauging / SIR Equipment <br />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 preform leak detection monitoring <br />Complete the following checklist: <br />Yes <br />FINo ' <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />Yes <br />❑ No " <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />Yes <br />F�No • <br />Was the accuracy of system product level readings tested? <br />Yes <br />F_�No . <br />Was accuracy of system water level readings tested? <br />Yes <br />❑No ` <br />Were all probes reinstalled properly? <br />❑ Yes <br />®No • <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />G. Line Leak Detectors (LLD) : <br />Complete the following checklist: <br />Check this box if no tank gauging or SIR equipment is installed. <br />® Yes ®No' <br />N/A <br />For equipmentstart-up or annualequipmentce i ca ion, was a ea simulatedo verify pe . ormance <br />(Check all that apply) Simulated leak rate: ® 3 g.p.h ❑ 0.1 g.p.h [:] 0.2 g.p.h <br />® Yes ® No * <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />® Yes F-1 No * <br />Was the testing apparatus properly calibrated? <br />® Yes F� No . <br />® N/A <br />1 For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />EJYes ❑ No * <br />❑ N/A <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />© Yes 7 N * <br />N/A <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected. <br />Yes No' <br />N/A <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a tes4. <br />® Yes❑ No * <br />F-1N/A <br />or electronic LLDs, have all accessible wiring connections been visually inspected? <br />IE]Yes❑ No * <br />I ____Fere <br />all items on the equipment manufacturer's maintenance checklist completed? <br />* In the Section H, below, describe how and when these deficiencies were or will be corrected. <br />H. Comments: <br />page <br />