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onitoring System Certification <br /> Site Address: 4627 DA VINCI DR. Date of Testing/Service: 06/25/2001 <br /> c@ MARCH LN. <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 preform leak detection monitoring <br /> Complete the following checklist: <br /> Yes F_�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 FjNo* Was the 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 [:]No. Were all items on the equipment manufacturer's maintenance checklist completed? <br /> G. Line Leak Detectors (LLD) : Check this box if no tank gauging or SIR equipment is installed. <br /> Complete the following checklist: <br /> For equipment start-up or annual equipment certification,was a leak simulated to verify performance? <br /> ® Yes ❑ No* ❑N/A (Check all that apply)Simulated leak rate:[!]3 g.p.h Q 0.1 g.p.h E:]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* 0 N/A For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> E]Yes F-I No* ® N/A For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> Ej Yes E]No* ® N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> Yes M No* N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> E]Yes []No* ® N/A or electronic LLDs,have all accessible wiring connections been visually inspected? <br /> ®Yes ❑No ere 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 /> NO SENSOR OUT SHUTDOWN. <br /> page 3 of 3 <br />