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0 9 <br />F. j In -Tank Gauging /SIR Equipment: ® Check this box if tank gauging is us to <br />El Check this box if no tank gauging or is i RAVED <br />This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. <br />Complete the following checklist: it it a CA MI <br />❑ Yes <br />❑ <br />No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />❑ Yes <br />❑ <br />No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? ENVIRONMENTAL <br />❑ Yes <br />❑ <br />No* <br />Was accuracy of system product level readings tested? <br />DEPARTMEWF <br />❑ Yes <br />❑ <br />No* <br />Was accuracy of system water level readings tested? <br />❑ Yes <br />❑ <br />No*Were <br />all probes reinstalled properly? <br />❑ Yes <br />11No* <br />® N/A <br />Wen= all items on the equipment manufacturer's maintenance checklist completed? <br />In Section H, below,describe how and when these deficiencies were or will be corrected. <br />.ine Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. <br />Cmmnle4a fha fniinminn wHnw4line. <br />® Yes <br />❑ No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) <br />❑ N/A <br />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 rfgulatory requirements? <br />® Yes <br />❑ No* <br />Was the testing apparatus properly calibrated? <br />® Yes <br />❑ No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ N/A <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />® N/A <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br />® N/A <br />No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br />N/A <br />L❑ <br />❑ No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />N/A <br />❑ No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />In Section H, below, describe how and when these deficiencies were or will be corrected. <br />t <br />H. Comments: Leak Detector <br />DSL — Not tested <br />DSL ab 170 160 6 28 21 PASS <br />91 1130 2 27 22 PASS <br />87 failed * to be repaired and retested by Walton <br />RED DSL 160 3 26 14 PASS <br />DSL 2 170 4 26 12 Pass <br />Monitoring System Certification Page 3 of 4 2/21/07 <br />