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F. In-Tank Gouging/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 sectlon must be completed if in-tank gauging equipment Is used to perform leak detection monitoring. <br /> Complete the following checklist: <br /> Yes No* Has all inputwiring been inspected for proper entry and termination,Including testing for ground faults? <br /> R Yes 0 No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ® Yes ❑ No* Was accuracy of system product level readings tested? <br /> F/_1 Yes ❑ No* Was accuracy of system water level readings tested? <br /> F./] Yes ❑ No* Were all probes reinstalled properly? <br /> ® Yes ❑ 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 /> G. Line Leak Detectors(LLD): Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> ❑ YesNo* For equipment start-up or annujLequipmen rtification,}mss a leak simulated to verify LLD performance? (Check all <br /> 0NIA that apply,} Simulated leak rate:lJ 3 g.p.h.;Li O.i g.p.h ;M 0.2 g.p.h. <br /> Yes No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> Yes 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 o* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> NIA <br /> ❑ Yes No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or <br /> WA disconnected? <br /> ❑ Yes No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or <br /> WA falls a test? <br /> Yes No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> ❑ N/A <br /> Yes No* I 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 /> RECEIVED <br /> AL 17201 <br /> ENVIRONMENTAL <br /> HEMALTH EPP_,,RTM _T <br /> Monitoring System Certification Page 3 of 4 12107 <br />