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06/18/2013 11:36AM FAX 2003330318 KSH CORP Cj 0004/0006 <br />F. <br />In -Tank Gauging I SIR Equipment: Check this box K tank gauging is used only for Inventory control. <br />❑ Check this lox if no tank gauging or SIR equipment is lnstatkidl. <br />This itection must be complisted if in -tank gauging equipment Is used ig perform teak doloction monitoring. <br />Complete lite following chocklist: <br />® YC3 <br />❑ <br />No" <br />Has all Input wiring been inspooled for proper entry and termination, including testing for ground faults? <br />® Yes <br />❑ <br />No" <br />Were alt lank gauping probes visually Inspected for damw and residue buildup? <br />10 Yes <br />❑ <br />Na" <br />Was &=racy of system product level readings torted? <br />® yes <br />❑ <br />No- <br />Was accuracy of systom Water level reading% tested? <br />® Yes <br />❑ <br />No° <br />Were all probes reinstalled property? <br />Ila Yea <br />0 <br />No- <br />1 Were all items on the equipment manufacturer's maintenance ohowist corn od? <br />" In Section h, Dmw, ciascribc now and wmn mese gencloncmea were or wnl Do corroma. <br />Line Look Detecterms (LLD): ® Check this box it LLD& aro not installed. <br />Pw.wnl.Aa 6Aw FML - —A.. rlw►41i.c9 <br />® Yes <br />❑ <br />No" <br />For equipment start-up or annual equipment certification, was a leak simulated to vetiiy LLD pertormar 7!1Cheok an 1 at apply) <br />❑ <br />NIA <br />Simulated teak rate: ® 3 g.p.h.; ❑ o.t g.p.h : ❑ 0.2 g,p.h. <br />L3 Yes <br />❑ <br />No` <br />Were all LLD* confirmed operational and s=urate within regulatory requiromw t3T <br />® Yes <br />❑ <br />No' <br />Was the testing apparatus properly calibrated? <br />Yes <br />❑ <br />Ne <br />For medlhanical LLOs, does the LLD restrict product flow N it detects a leak? <br />® <br />NIA <br />Yes <br />❑ <br />No" <br />For Oftwic I.I.M. does the turbine automatically shut OR it the LLD deWA a leak? <br />❑ <br />NIA <br />® Yes <br />❑ <br />tom" <br />For electronic LLD%, does the turbine automatically shut off If any porton of tho monitoring system Is disabled or disccmneetrd <br />❑ <br />NA <br />® Yes <br />❑ <br />No, <br />For electronic LLN, does the turbine automatically shut off If any porton of the monitoring system matunotions or faits a test? <br />❑ <br />NIA <br />® Yo* <br />❑ <br />Ne" <br />For erettronic LLQs, have all acceasibla wiring conneedats been visually inspected? <br />❑ <br />NIA <br />to Yes <br />❑ <br />No° <br />Were all items on the equipment manufacturer's maintenance ehoddGat completed? <br />- in m amnuo now ane wrten Una" ganUMIMIq$ weie ear will nC rUMM 9. <br />H. commer".1 <br />Monwring System Certification <br />Fags 3 of 4 <br />