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lonitoring System Certification Site Address: 10858 TRINITY PKWY F. In -Tank Gauging / SIR Equipment Check this box if no tank gauging or SIR equipment is installed. Date of Testing/Service: 10/17/2008 ❑ Check this box if tank gauging is used only for inventory control. ❑ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: ❑ Yes ❑x No • Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ❑ Yes QNo • Were all tank gauging probes visually inspected for damage and residue buildup? ❑ Yes QNo' Was accuracy of system product level readings tested? 1:1 Yes ❑x No • Was accuracy of system water level readings tested? Yes F]No Were all probes reinstalled properly? ❑ Yes No Were all items on the equipment manufacturers' maintenance checklist completed? ' In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD) : ❑ Check this box if LLDs are not installed. Complete the following checklist: Yes ❑ No • E] N/A For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) Simulated leak rate: ❑ 3 g.p.h ❑ 0.1 g.p.h ❑0.2 g.p.h X Yes ❑ No • Were all LLDs confirmed operational and accurate within regulatory requirements? FXTJ Yes ❑No' Was the testing apparatus properly calibrated? ❑X Yes ❑ No • ❑ N/A For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ Yes ❑No' ❑X N/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑ Yes ❑No • M N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? ❑ Yes ❑No' ❑X N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? ❑ Yes ❑No • 0 N/A For electronic LLDs, have all accessible wiring connections been visually inspected? Yes ❑No • Were all items on the equipment manufacturers' maintenance checklist completed? ' In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: Page 3 of 3 Based on CA form dated 03/01