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�H, <br />F. In -Tank Gauging / SIR Equipment: ❑ Check this box if tank gauging is used only for inventory control. <br />0 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 perform leak detection monitoring. <br />n....,...1..�.. ♦I.w Fwliw...i.... wMww Ll:w!• .., .. .,.. <br />❑ <br />Yes <br />❑ <br />No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />❑ <br />Yes <br />❑ <br />No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />❑ <br />Yes <br />❑ <br />No* <br />Was accuracy of system product level readings tested? <br />❑ <br />Yes <br />❑ <br />No* <br />Was accuracy of system water level readings tested? <br />❑ <br />Yes <br />❑ <br />No* <br />Were all probes reinstalled properly? <br />❑ <br />Yes <br />❑ <br />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 />G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. <br />f-..w...1..Fw •Mw iw Al*....:n.. whew Lliwtr• <br />o Yes <br />❑ <br />No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all <br />❑ <br />N/A <br />that apply) Simulated leak rate: 9 3 g.p.h.; ❑ 0.1 g.p.h; ❑ 0.2 g.p.h. <br />❑ Yes <br />z <br />No* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />© Yes <br />❑ <br />No* <br />Was the testing apparatus properly calibrated? <br />❑ Yes <br />❑ <br />No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />2 <br />N/A <br />❑ Yes <br />❑ <br />No <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />0 <br />N/A <br />_7 Yes <br />❑ <br />No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or <br />Z <br />N/A <br />disconnected? <br />❑ Yes <br />❑ <br />No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or <br />2 <br />N/A <br />fails a test? <br />❑ Yes <br />❑ <br />No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />Z <br />N/A <br />P1 Yes <br />❑ <br />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: Leak Detector did not <br />Monitoring System Certification Page 3 of 4 <br />12/07 <br />3 2/21/07 <br />