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GETTIM-RYAN INC. GR Job# 17202518 <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 /> Complete the following checklist: <br /> Has all input wiring been inspected forproper en and termination,including testing for rofilults? <br /> � es ❑ o P 9 P entry 9 9 9 <br /> IS Yes ❑ No' Were all tank gauging probes visually inspected for damage and residue buildup? <br /> Q Yes ❑ No* Was accuracy of system products level readings tested? <br /> IX Yes ❑ No* Was accuracy of system water level readings tested? <br /> C[ Yes ❑ No* Were all probes reinstalled properly? <br /> Ig Yes 1 ❑ No* lWere all items on the equipment manufacturer's maintenance checklist completed? <br /> ' n the Section R,Felow,describe how and when W—m'deficlencles were or will be corrects <br /> G. Line Leak Detectors(LLD): ❑ Check this box if LLDs are not installed. <br /> Complete the foilowing checklist: <br /> 1Z Yes ❑ o or equipment start-up or annual equipment certifi on,was a leak simulated o venly LLD performance?( (check all <br /> ❑ NIA that apply)Simulated leak rate: ® 3 g.p.h. ❑ 0.1 g.p.h. ❑ 0.2 g.p.h. <br /> IH Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> Ig 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 /> (g NIA <br /> Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ❑ N/A <br /> 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 /> Ig 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 /> Ig Yes ❑ No' For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> ® N/A <br /> Ig Yes ❑ No' were all items on the equipment manufacturer's maintenance checklist completed? <br /> In the Section H,below,describe ow and when these de ciencles were or will be co <br /> G. Comments: <br /> Monitoring system Certification Page 3 of 4 12107 <br /> 3 <br />