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nitoring System Certification <br />Site Address: 1725 ACKERMAN DR Date of Testing/Service: <br />F. In -Tank Gauging / SIR Equipment <br />03/21/2001 <br />® 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 />IN Yes <br />❑ No • <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />® Yes <br />❑ No <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />® Yes <br />❑No • <br />Was the accuracy of system product level readings tested? <br />® Yes <br />❑No • <br />Was accuracy of system water level readings tested? <br />® Yes <br />❑No ` <br />Were all probes reinstalled properly? <br />® Yes <br />❑No• <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />G. Line Leak Detectors (LLD) : <br />Complete the following checklist: <br />❑ Check this box if no tank gauging or SIR equipment is installed. <br />® Yes <br />E] No * <br />For equipmentstart-up or annualequipmentcertification, was a ea simulatedo vera performance? <br />❑ N/A (Check all that apply) Simulated leak rate: ® 3 g.p.h ❑ 0.1 g.p.h ❑ 0.2 g.p.h <br />® Yes <br />❑ No' <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />® Yes <br />❑ No' <br />Was the testing apparatus properly calibrated? <br />® Yes <br />❑ No' <br />❑ N/A For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ Yes <br />No * <br />® N/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />❑ Yes <br />❑ No' <br />® N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br />Yes <br />No • <br />M N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test . <br />❑ Yes <br />❑ No • <br />®N/A or electronic LLDs, have all accessible wiring connections been visually inspected? <br />® Yes <br />❑ No ` <br />❑ N/A 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 />page 3 of 3 <br />