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F. In -Tank Gauging / SIR Equipment: El Check this box if tank gauging is used only for inventory control. <br />[3 Check this box it no tank gauging or SIR equipment is installed. <br />This section must be completed it in -tank gauging equipment is used to perform leak detection monitoring. <br />Pnmnlafa 1ho Winwinn rhm-kii0- <br />n, <br />Yes <br />[3 <br />No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />[] <br />Yes <br />[3 <br />No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />E] <br />Yes <br />[3 <br />No* <br />Was accuracy of system product level readings tested? <br />R <br />Yes <br />[3 <br />No' <br />Was accuracy of system water level readings tested? <br />R <br />Yes <br />[3 <br />No* <br />Were all probes reinstalled properly? <br />E] Yes <br />ā‘ <br />No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />- in the section m, veiow, aescnDe now ana when these cienciencies were or wiij ne correctea. <br />G. Line Leak Detectors (LLD): E] Check this box if LLDs are not installed. <br />th. fMI^ ... iā€” <br />Yes <br />No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check a# <br />N/A <br />that apply) Simulated leak rate: E] 3 g.p.h.;[:] 0.1g.p.h;00.2 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 />E] Yes <br />N <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 <br />N/A <br />disconnected? <br />Yes <br />No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or <br />N/A <br />fails a test? <br />E] Yes <br />No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />.H N/A <br />E] Yes <br />10 No- <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In the Section H, below, describe how and when these deficiencies were or will be corrected. <br />H. Comments: <br />Monitoring System Certification Page 3 of 4 <br />12/07 <br />3 2/21/07 <br />