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Monitoring System Certification <br />F. In -Tank Gauging/ SIR Equipment: ❑ Check this box iftank gauging is used only for inventory Control. <br />❑ Check this box if no tank gauging or SIR equipment is installed. <br />his section must be completed if in -tank gauging equipment is used to perform leak detection 'monitoring. <br />Complete the following checklist: <br />® Yes <br />❑ No* <br />Has all input wiring been inspected for propel' 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 accuracy of system product level readings tested? <br />9 Yes <br />❑ No* <br />Was accuracy of system water level readings tested? <br />0 Yes <br />Cl No* <br />Were all probes reinstalled properly? <br />® Yaes <br />❑ No* <br />Were a]I items on the equipment manufacturer's maintenance checklist completed? <br />In Section <br />H, below. dewrihe hnw 9nd whon thaep daffi- Pnnina were — —m hn ....-«nn6. 1 <br />G. Line Leak Detectors (LLD): <br />Comnlete the fallawina rhnr.kiief- <br />❑ Check this box if LLDs are not installed, <br />® Yes <br />❑ No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />a N/A <br />(Check all that apply) Simulated leak rate: 0 3 g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. <br />0 Yes <br />❑ No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />0 Yes <br />❑ No* <br />Was the testing apparatus properly calibrated? <br />Yes <br />C7 No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />Cl 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 />0 Noy` <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />p N/A <br />or disconnected? <br />❑ Yes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system maliilnctions <br />CI NIA <br />or fails a test? <br />❑ Yes <br />p No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />❑ NfA <br />0 Yes <br />© NO <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />a.. ,—......:., u. 117, ua+ & iL6 l6V rs '114 wavis mr,3%; uCAiCIBalutu F Were or wtu De correerm <br />PisivienuMENTAL HEALTH <br />DEPARTMENT <br />Page 3 of 4 <br />UN -036 - 516 evmy.unidomorg Rev. 011170 <br />