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` F. In -Tank Gauging I SIR Equipment: ❑ Check this box if tank gaug used only for inventory control. ❑ Check this box if no tank gauging or SIR eqi ment-is installed_ This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. L - Complete the following checklist: ❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? V MCI ❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? - yap 4� ❑ Yes ❑ No* Was accuracy of system product level readings tested? m ❑ Yes ❑ No* Was accuracy of system water level readings tested? ❑ Yes ❑ No* Were all probes reinstalled properly? ❑ Yes ❑ No* Were all items on the equipment manufacturers maintenance checklist completed? * In Section H, below, describe how and when these deficiencies were or will be corrected. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. Comnlata tha fniinwinn rharkliat- ® Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) ❑ N/A Simulated leak rate: ® 3 g.p.h.; [10.1 g.p.h ; [10.2 g.p.h. ® Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? ® Yes ❑ No* Was the testing apparatus properly calibrated? ® Yes ❑ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ® N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? ® N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? ® N/A ❑ Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? ® N/A ® Yes ❑ No* Were all items on the equipment manufacturers maintenance checklist completed? in aecaon m, oeiow, oescrioe now ano wnen mese aenclencles were or wnl oe correcrea. . H. Comments: 87 120 3 24 21 PASS 91 130 3 26 21 PASS DSL 140 3 30 23 PASS Monitoring System Certification Page 3 of 4 2/21/07