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10 0 <br />M/ GETTLER-RYAN INC. <br />F. In -Tank Gauging I 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 />This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. <br />Comolete the faflnwlnn checklist* <br />I'a <br />Yes <br />❑ <br />o <br />Has all input wiring been inspected for proper entry and termination, incuding testing for ground faults? <br />E <br />Yes <br />❑ <br />No' <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />E <br />Yes <br />❑ <br />NO* <br />Was accuracy of system products level readings tested? <br />E <br />Yes <br />® <br />No' <br />Was accuracy of system water level readings tested? <br />rX <br />Yes <br />® <br />No' <br />Were all probes reinstalled property? <br />E <br />Yes <br />❑ <br />No` <br />lWere all items on the equipment manufacturer's maintenance checklist completed? <br />G. Line Leak Detectors (LLD): ❑ Check this box it LLDs are not installed. <br />Comolete the fallowlna checklist! <br />r <br />es <br />® <br />o <br />or equipment start-up or annual equipment certification, was a leak gmul to verify LD performance? (check a# <br />❑ <br />N/A <br />that apply) Simulated leak rate: ® 3 g.p.h. ❑ 0.1 g.p.h. ❑ 0.2 g.p.h. <br />Yes <br />® <br />No` <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />[j <br />Yes <br />❑ <br />No" <br />Was the testing apparatus property calibrated? <br />❑ <br />Yes <br />❑ <br />No' <br />For Mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />N/A <br />[j <br />Yes <br />❑ <br />No' <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />❑ <br />N/A <br />ff <br />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 />❑ <br />N/A <br />Disconnected? <br />R <br />Yes <br />❑ <br />No' <br />For electronic LLDs, does the turbine automatically shut oft if any portion of the monitoring system malfunctions or <br />❑ <br />N/A <br />fails a test? <br />ra <br />Yes <br />❑ <br />No" <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />® <br />N/A <br />Yes <br />®No` <br />were all items on the equipment manufacturer's maintenance checklist completed? <br />C • rrillMI <br />Monitoring System Certification Page 3 of 4 12!07 <br />9 <br />