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Monitoring System Certification <br />Site Address: 35 N. CHEROKEE LANE Date of Testing/Service: 04/12/2001 <br />@ ELM <br />F. In -Tank Gauging / SIR Equipment ® Check this box if tank gauging is used only for inventory control. <br />El 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 <br />E] 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 />FjNo * <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 manufacturers maintenance checklist completed? <br />G. Line Leak Detectors (LLD) : <br />Complete the following checklist: <br />F] Check this box if no tank gauging or SIR equipment is installed. <br />® Yes <br />E] No <br />N/A <br />For equipment start-up or annual equipment certification, was a leak simulated to verify performance? <br />(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 <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />Yes <br />I [:]No* <br />® N/A <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />Yes <br />E]No * <br />® N/A <br />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 />N/A <br />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 <br />or electronic LLDs, have all accessible wiring connections been visually inspected? <br />® Yes <br />F� No * <br />ere all items on the equipment manufacturers 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 <br />