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FEB -16-2016 01:53P FROM: Tn,4683433 P.6/8 <br />F. WTank C aging I SIR Equi 10 Ct" this box t tank gouging is used only for in <br />D Chock this box if no tank gauging or SIR egddprre <br />EIVEUr <br />This sscfiw asst be oornpleled it irwtank gauging equipment is used to perform leak detection mon <br />Ctmfpieta the following checklist 2016 <br />® Yea ❑ No' Hee ap -Input widng been Inspected for proper entry and n, kudu ding testing for ground faults? <br />® Yes ® No' We d tank gauging probes visually Inspected for den rage and residue buildup?NTA <br />® Yea ❑ No' Yvan accuracy of system product level <br />® Yes ❑ NW Was &=racy Of system water lam] readings tasted? <br />® Yea ❑ No' K%m sA ;= reinstalled proporty? <br />® Yea ❑ No* Were all /terns on the equipment t emrfeeturer's maintenance checklist ? <br />• In section H, below, describe hand and when these Oclenclas ware or MIT* =acted. <br />Line to* Detectors 1LLD): ❑ Check this box if LLDS are not installed. <br />r—.W. One WL—An. ntunb3e.s. <br />Yea <br />❑ <br />No' <br />For equipment Ma" or annual equipment certification, was a leak akrwtsted to varittr LLD parfomuanco? (Chock aff drat apply) <br />❑ <br />N/A <br />Slatulated leak lata: ® 3 g.p,h.: ❑ 0.1 g.p.h ; ❑ 0.2 g p.h. <br />Yes <br />❑ <br />NF— <br />Were all LLDS canfirrrad operational and accurate within latory requirements? <br />® Yes <br />® <br />No" <br />Was the tasting apparatus property calibrated? <br />❑ Yes <br />❑ <br />No' <br />For mechanical LLOs, does the LLA mW product flew if it dateare a took? <br />® <br />N/A <br />® Yes <br />❑ <br />No* <br />For electronic LLAa, sloes the turbine automatically shut off if the LLD detects a beak? <br />❑ <br />NIA <br />® Yee <br />❑ <br />No* <br />For OW01rordo LLD$. does the turbine automatically shut off If any portion of the monitoring system Is disabled or disconnected? <br />❑ <br />NIA <br />® Yes <br />❑ <br />No* <br />For electronic LLDS, does the turbine aukmuicelly shut off 0 am portion of the mordwring system malfunctions or fails a teat? <br />❑ <br />N/A <br />1$1 Yea <br />❑ <br />No• <br />For alac honic LLDS, have all accessible whing connections been visually Inspected? <br />❑ <br />NIA <br />® Yes <br />❑ <br />Na' <br />Were all Item on Nue equipment manufacturer's mabntanenc a checklist completed? <br />* In Section H, bafow, describe hoax and when these d ianofes were or ell Correa . <br />H. Commerrti: <br />MonlWring System Certiflcollon Page 3 of 4 2/21/07 <br />