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UNDERGROUNI&ORAGE TANK MONITORING SYSTE RTIFICATION <br /> F. In-Tank Ganging/SIR Equipment: Permit Number: <br /> ❑ Check this box if tank gauging is used only for inventory control <br /> ❑ Check this box if no tarsi:gauging or SIR�pmentasInstalled <br /> This section must be completed if in-t ' � u or equipment is used to perform leak detection monitoring. <br /> Complete the following checklist: <br /> ❑ Yes ❑ No* Has all input wixzng ben inspected for proper entry and termination,including testing for ground faults? <br /> ❑ Yes I ❑ No* Were all tank gauging robes visually inspected for damage and residue buildup? <br /> ❑ Yes ❑ No* Was accuracy of system;product level readings tested? <br /> ❑ Yes I ❑ No* Was accuracy of system water level readings tested? <br /> ❑ Yes 10 No* j Were all probes reinstalled prope`31y? <br /> ❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> In Section H below,d::scribe how and when these deficie)bo <br /> es were or will be corrected. <br /> G. Line Leak Detectors (LLD): Z! Check this if LLDs are not installed. <br /> Complete the following checklist: <br /> ❑ Yes ❑ No* For equipment start-up or annual a ipment certification, was a leak simulated to verify LLD performance? <br /> ❑ NIA (Check all that apply) Simulated le rate: ❑3 g.p.h.; ❑0.1 g.p.h. ❑0.2 g.p.h. <br /> ❑ Yes ❑ No* Were all LLDs confirmed opera oral and accurate within regulatory.requirements? <br /> ❑ Yes ❑ No* Was the testing apparatus prop ly calibrated? <br /> ❑ Yes ❑ No* For mechanical LLDs,does.the LD restrict product flow if it detects a leak? <br /> ❑ 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 <br /> ❑ N/A or disconnected? \1 11 <br /> ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions <br /> ❑ NIA or fails a test? <br /> ❑ Yes ❑ No* For electronic LLDs,have all accessible wiring connections been visually.inspected? <br /> ❑ NIA ° <br /> ❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> *In Section H below,-describe-how and-when these deficiencies were or will be corrected. <br /> f. <br /> H. Comments: <br /> 17 <br /> DEME M,-9301.(Rev 08/02). .. 'age 3 of 4 County o€San Diego-DEH-Hazardous Materials Division, <br />