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/'ETTtFdRYAN JNC. <br /> GR Job 20-641524 <br /> U <br /> F. In-Tank Gauging/SIR Equipment: ❑ Check this box if tank gauging is used only for inventory cont <br /> ❑ Check this box if no tank gauging or SIR equipment is ns a IAUG. <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. G 1 2016 <br /> Complete the following checklist: <br /> ff es --O---NO— Has all input Wring been inspected for proper entry and termination,including testing for ground faults? <br /> ff Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ff Yes ❑ No* Was accuracy of system products level readings tested? <br /> Ij Yes ® No* Was accuracy of system water level readings tested? <br /> JH Yes ® No* Were all probes reinstalled property? <br /> it ff Yes 1 ❑ No` Were all items on the equipment manufacturer's maintenance checklist completed? <br /> 'In the Section H,below,ilescribe 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 /> Complete the following checklist: <br /> f es ❑ o or equipmen s a -up or annual equipment certification,was a ieaK simulated to verify performance?(check all <br /> ❑ N/A that apply)Simulated leak rate: ® 3 g.p.h. ❑ 0.1 g.p.h. ❑ 0.2 g.p.h. <br /> 9 Yes ❑ No` Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> IA– Yes ® No* Was the testing apparatus properly calibrated? <br /> ❑ Yes ® No* For Mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> N/A <br /> [Z Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ❑ N/A <br /> rA Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or <br /> ❑ N/A Disconnected? <br /> (I Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or <br /> ® N/A fails a test? <br /> (Z Yes ❑ No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> ❑ N/A <br /> [I Yes ❑ =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 corrected. <br /> G. Comments: <br /> Monitoring System Certification Page 3 of 4 12/07 <br /> 3 <br />