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ED <br /> F. In Tank Gauging I SIR Equipment: Check this box if tank gauging is u Fw.(;FwltVr <br /> P, 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. NOV 19 2014 <br /> Com lets the falfowin checklist: H <br /> x Ye;--7—No- Has all input wiring been inspected for proper entry and termination,including testi <br /> U Yes x No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> [I Yes x Ne Was accuracy of system product level readings tested? <br /> n Yes x No* Was accuracy of system water level readings tested? MT77 <br /> U, Yes x No* Were all probes reinstalled properly? <br /> H-x Yes I P. Ne I Were all items on the equipment manufacturer's maintenance checklist completed? <br /> •In the Section H,Wow,describe how and when th ficiencies were or will be corrected. <br /> G. Line Leak Detectors(LLD): U Check this box if LLDs are not installed. <br /> Com tete ,following checklist: <br /> 0 Yes Ne For equipment start-up or annualequipment certification,was a leak simulated to verify L performance?(Check all <br /> ❑ 0 <br /> NIA that apply) Simulated leak rate: u 3 g.p.h.; E 0.1 g.p.h; E 0.2 g.p.h. <br /> c. Yes Ei No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> V� <br /> Li Yes o No0.* Was the testing apparatus properly calibrated? <br /> ❑ Yes No- F- - LD restrict product flow if it <br /> For mechanical LI-Ds,does the L detects a leak? <br /> ❑ NIA <br /> ci Yes 0 No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> — u N/A <br /> o Yes 1-1 No- For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or <br /> u N/A disconnected? <br /> [I Yes r-j No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or <br /> 0 NIA fails a test? <br /> ci Yes 7—No- Far electronic LLDs,have all accessible wiring connections been visually inspected? <br /> u NIA <br /> — <br /> Elyes n Ne Were all items on the equipment manufacturers maintenance checklist completed? <br /> *In the Section H,below,aescribe how and when these deficiencies were or will be corrects <br /> H. comments: See leak detector form._- - <br /> Monitoring System certification Page 3 of 4 12107 <br /> 3 2/21/07 <br />