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t4 Y <br /> 0 <br /> F. In Tank Gauging I SIR Equipment. 0 Check this box if tank gauging is used only for inventory control. <br /> 0 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 /> x Yes 0 No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> 0 Yes x No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> b Yes x Ne Was accuracy of system product level readings tested? <br /> 0 Yes x Ne Was accuracy of system water level readings tested? <br /> C3 Yes x No* Were all probes reinstalled properly'? <br /> x Yes 1 <br /> i No* were all item on the equipment manufacturer's maintenance checklist completed? r 11 ir <br /> In the Section H,below,describe how and when time deficiencies were or will be corrected. %.,o I V LJ <br /> G. Line Leak Detectors(LLD): 0 Check this box if LLDs are not installed. NOV 0 7 2016 <br /> Complete the followinvMg checklist: <br /> x Yes 0 No* For equipment start-up or annual equipment certification,was a leak simulated to vet'WftMM-RM,�LTH <br /> 0 NIA that apply) Simulated leak rate: x 3 g.p.h.; 0 0.1 g.p.h; 0 0.2 g.p.h. <br /> x Yes 0 No* Were all LUX confirmed operational and accurate within regulatory requirements? DEPARTMENT <br /> x Yes o No* Was the testing apparatus properly calibrated? <br /> x Yes 0 No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> 0 N/A <br /> 0 Yes 0 NW For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> x NIA <br /> 0 Yes 0 No* For electronic LI-Ds, does the turbine automatically shut off if any portion of the monitoring system is disabled or <br /> x NIA disconnected? <br /> 0 Yes 0 No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or <br /> x WA fails a test? <br /> 0 Yes 0 No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> x NIA <br /> x Yes 11 No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> In the Section H,below,descdbe how and when these deficiencies were or will be corrected. <br /> H. Comments: See leak detector form. <br /> Monitoring System Certification Page 3 of 4 11=7 <br /> 3 2/21/07 <br />