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1 1 <br /> F. In-Tank Gauging/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 No" Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> ❑ Yes ❑ 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 /> ❑ Yes ❑ No* Was accuracy of system water level readings tested? <br /> ❑ Yes ❑ No* Were all probes reinstalled properly? <br /> ❑ Yes I ❑ 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 /> JUL17 2-018 <br /> G. Line Leak Detectors(LLD): O Check this box if LLDs are not installed. <br /> Complete the following checklist: ENVIRONMENTAL <br /> ❑ Yes No* For equipment start-up or annu" IU qulpmen�ertlf!cation,Ms a leak simulated to verify ,_ . <br /> N/A that apply) Simulated leak rate: 3 g.p.h.; 0.1 g.p.h; 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 LLD&,does the LLD restrict product flow if it detects a leak? <br /> N/A <br /> Yes 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 /> ❑ N/A disconnected? <br /> 77 Yes No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or <br /> N/A fails a test? <br /> ❑ Yes ❑ No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> ❑ N/A <br /> IJ Yes U U 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 />