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Monitoring System Certification <br />F. In -Tank Gouging/ SIR Equipment: ❑ 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 />\ 'Phis section must be completed if in -tattle gaining eciuipment is used to perform leak detection monitoring. <br />Complete the follpwing checklist: <br />0 Yes <br />G. <br />❑ No* <br />ll input wiring been inspected for proper entry and termination, including testing for ground faults? <br />Yes <br />Q No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />® Yes <br />p No* <br />Was accuracy of system product level readings tested? <br />® Yes <br />E) No* <br />Was accuracy of system water level readings tested? <br />Yes <br />MC� <br />© No* <br />Were all probes reinstalled properly? <br />� Yes No* Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In the Sectinn H. hetnw_ Ilacor4hn h_, .....1 ...L . LL _ J�l1_1_---- <br />_- <br />G. Line Leak Detectors (LLD): <br />t•'_nilltlWp the f^11n 4nn nhnnl.l:e.. <br />•-- •• +•..+........... a 11 va v V1 TV411 ug: EVI A vq;tcu. <br />Cl Check this box if LLDs are not installed. <br />H. Comments: <br />a <br />ENVIRONMENTAL HEALTIj <br />DEPARTMENT <br />❑ No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />❑ N/A <br />(Check all that apply) Simulated leak rate: ® 3 g.p.h.; ❑ 0.1 g.p.h ; [10.2 g.p.h. <br />FVe <br />C] No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />Q No* <br />Was Lite testing apparatus properly calibrated? <br />❑ No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />0 N/A <br />❑ Yes <br />CJ 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 <br />N/A <br />or disconnected? <br />❑ Yes <br />p No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br />N/A <br />malfunctions or fails a test? <br />F1 Yes <br />Q No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />N/A <br />,Yes <br />❑ No* <br />Were all Items on the equipment manufacturer's maintenance checklist completed? <br />In the <br />Section H. <br />below. describe how and when theca do4UL&,% •4Pe wwro nr —411 hn -n f -A <br />H. Comments: <br />a <br />ENVIRONMENTAL HEALTIj <br />DEPARTMENT <br />