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0 * RECEIVED <br /> F. In-Tank Gauging/SIR Equipment: X Check this box if tank gauging is used only for invet 2016 <br /> i Check this box if no tank gauging or SIR equipment jg nstaej <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. ENVIRONMENTAL HEALTH <br /> Complete the following checklist: <br /> Yes ; No* Has all input wiring been inspected for proper entry and termination,including testing for ground au s. <br /> Yes r:; No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> Yes a No* Was accuracy of system product level readings tested? <br /> Yes a No* Was accuracy of system water level readings tested? <br /> Yes ri No* Were all probes reinstalled properly? <br /> Yes U No" Were all items on the equipment manufacturers maintenance checklist completed? <br /> *In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors(LLD): (X)Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> Yes I; No. For equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance?(Check all <br /> N/A that apply) Simulated leak rate: u 3 g.p.h.; D 0.1 g.p.h; _i 0.2 g.p.h. <br /> Yes u No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> Yes n No* Was the testing apparatus properly calibrated? <br /> Yes No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> N/A <br /> Yes L! No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> N/A <br /> Yes ❑ No* For electronic LLDs, does the turbine automatically shut off If any portion of the monitoring system is disabled or <br /> NIA disconnected? <br /> Yes ! No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or <br /> N/A falls a test? <br /> Yes No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> L1 NIA <br /> Yes n No* Were 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 /> Monitoring System Certification Page 3 of 4 12107 <br /> 3 2/21/07 <br />