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0 0 WO -8286 <br />Monitoring System Certification <br />F. In -Tank Gauging / SIR Equipment: <br />El 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 />C1 Yes <br />C3 No* <br />Has still input wiring been inspected for proper envy and termination, including testing for ground faults'.) <br />C] Yes <br />E] No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />E] Yes <br />C] No* <br />Was accuracy of system product level readings tested? <br />a % a Rom AM <br />rl Yes <br />0 No* <br />Was accuracy of system water level readings tested'? KMOVEET <br />C] Yes <br />C]No* <br />Were all probes reinstalled properly'? c- <br />-:p 1 1 2017 <br />0 Yes <br />[]No* <br />-.4 <br />Were all items on the equipment manuf'acturer's maintenance checklist completed? <br />In the Section H, below, describe how and when these deficiencies were or will be corrected. r-NVIKUNMtNIAL HEALTH <br />PERMIT/SERMES <br />G. Line Leak Detectors (LLD): <br />Com plet the following checklist: <br />[I Check this box if LLDs are not installed. <br />El Yes <br />[I No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />ONiA <br />(Check all that apply) Simulated leak rate: [] 3 g.p.h.: E] 0.1 g.p.h : E] 0.2 g.p.h. <br />E] Yes <br />E] No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements'? <br />El Yes <br />E]No* <br />Was the testing apparatus properly calibrated? <br />El Yes <br />E]No* <br />l <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak'? <br />E]NiA <br />E]Yes <br />E]No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak'? <br />EIN/A <br />El Yes <br />E]No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />El NNIA <br />or disconnected? <br />El Yes <br />0 No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions <br />ON/A <br />or fails a test? <br />Y­ <br />No* <br />For electronic LI.Ds, have all accessible wiring connections been visually inspected? <br />" <br />LIEl <br />EIKIA <br />OY <br />ONo*J <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />in tile wction H, ilciow, describe how and when these deficiencies were or will be corrected. <br />H. Comments: <br />Page 3 of 3 <br />