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F. In -Tank Gauging / SIR Equipment: ® Check this box if tank gauging is used only for inventory " <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. JUN 2016 16 <br />Complete the following checklist: <br />" In Section H, below, describe now and wnen tnese aenclencies were or wm ne correctea. <br />Line Leak Detectors (LLD): <br />1�.......1..F.. 44.w F..II.....i r... nHe.n Llicl• <br />ElCheck this box if LLDs are not installed. <br />® Yes <br />[INo* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) <br />® Yes <br />❑ <br />No* <br />Has all input wiring been inspected for entry and termination P 9 P P P rY including testing for 9 ground faults? <br />® Yes <br />ElNo* <br />ElNo* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />® Yes <br />ElNo* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />Was accuracy of system product level readings tested? <br />® Yes <br />[INo* <br />ElYes <br />Was accuracy of system water level readings tested? <br />® Yes <br />ElNo* <br />® N/A <br />Were all probes reinstalled properly? <br />® Yes <br />ElNo* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br />I Were all items on the equipment manufacturer's maintenance checklist completed? <br />" In Section H, below, describe now and wnen tnese aenclencies were or wm ne correctea. <br />Line Leak Detectors (LLD): <br />1�.......1..F.. 44.w F..II.....i r... nHe.n Llicl• <br />ElCheck this box if LLDs are not installed. <br />® Yes <br />[INo* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) <br />ElN/A <br />Simulated leak rate: ® 3 g.p.h.; El0.1 g.p.h ; El0.2 g.p.h. <br />® Yes <br />ElNo* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />® Yes <br />ElNo* <br />Was the testing apparatus properly calibrated? <br />® Yes <br />ElNo* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />ElN/A <br />ElYes <br />ElNo* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />® N/A <br />ElYes <br />ElNo* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br />® N/A <br />ElYes <br />❑ No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br />® N/A <br />ElYes <br />ElNo* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />® N/A <br />® Yes <br />❑ No* <br />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 />H. Comments: <br />Monitoring System Certification Page 3 of 4 2/21/07 <br />