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0 0 REQEIVED <br />IF. In -Yank ('7auging / SIR Equipment: Check this box if tank gauging is used only for inventory con of. <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. FEB 0 E® 2014 <br />Complete the following checklist: 01 <br />Yes <br />El <br />No* <br />I=— U <br />Has all input wiring been inspected for proper entry and termination, inciuding testing for ground faults? HFALTH DEPARTM <br />Yes <br />0 <br />No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />Yes <br />El <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 />"ITT <br />No* <br />Were all probes reinstalled properly? <br />Yes <br />❑ <br />No' <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />- in aecuon m, aetow, oescriDe now and when these deficiencies were or will be corrected. <br />Line Leak Detectors (LLD): El Check this box if LLDs are not installed. <br />Yes <br />❑ <br />No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) <br />❑ <br />N/A <br />Simulated leak rate: 0 3 g.p.h.; [10.1 g.p.h; El 0.2 g.pA <br />Yes <br />❑ <br />No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />Yes <br />❑ <br />No* <br />Was the testing apparatus properly calibrated? <br />Yes <br />❑ <br />No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ <br />N/A <br />❑ Yes <br />❑ <br />No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />N/A <br />0 Yes <br />0 <br />No* <br />For electronic LI -Ds, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br />0 <br />N/A <br />[I Yes <br />[3 <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 />0 <br />N/A <br />❑ Yes <br />0 <br />No* <br />For electronic LLDs, have all accessible Wring connections been visually inspected? <br />N/A <br />Yes <br />❑ <br />No* <br />Were all items on the equipment manufacturers maintenance checklist completed? <br />He Comments: <br />Monitoring System Certification Page 3 of 4 2/21/07 <br />bi <br />