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El <br />F. In -Tank Gauging I SIR Equipment: ® 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 perform leak detection monitoring. <br />Complete the following checklist: <br />❑ Yes <br />❑ <br />No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />❑ Yes <br />❑ <br />No- <br />Were all tank gauging probes visually Inspected for damage and residue buildup? <br />❑ Yes <br />❑ <br />No* <br />Was accuracy of system product level readings tested? <br />❑ Yes <br />❑ <br />No* <br />Was accuracy of system water level readings tested? <br />❑ Yes <br />❑ <br />No` <br />Were all probes reinstalled properly? <br />❑ Yes <br />1 ❑ <br />No' <br />I Were all items on the equipment manufacturer's maintenance checklist completed? <br />in Section H, below, describe how and when these deficiencies were or will be corrected. <br />Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed, <br />P..,....1..#s [4.n [nnnwinn nknn4icf• <br />❑ Yes <br />❑ No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) <br />❑ NIA <br />Simulated leak rate: ❑ 3 g.p.h.; [10.1 g.p.h ; ❑ 0.2 g.p.h. <br />❑ Yes <br />Cl No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />❑ Yes <br />❑ No' <br />Was the testing apparatus properly calibrated? <br />❑ Yes <br />❑ No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />NIA <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />® NIA <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br />NIA <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br />NIA <br />❑ Yes <br />❑ No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />0 NIA <br />❑ Yes <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* in Section H, below, describe how and when these deficiencies were or will be corrected. <br />H. Comments: <br />NO L/D TESTING TODAY <br />Monitoring System Certification mage 3 of 4 2121/07 <br />