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MONIT ING SYSTEM CERTIF#ATION <br /> CERTIFICATION I TEST DATE; Septemeber 2, 2011 <br /> Ai. FACILITY A2. OWNER <br /> Name <br /> 7-Eleven Market#2368!Store#14117 game 7-Eleven, Inc <br /> Address 2725 Country Club Lane,Stockton,CA 95201 Address P.O.Box 711,Dallas,TX 752 <br /> 21 <br /> Phone# 209-463-1259 Phone# 605-523-2949 <br /> Contact Stephen Boyd <br /> Contact Stephen Boyd <br /> F. IN-TANK GAUGING/ 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 gaugung equipment is used to perform leak detection monitoring. <br /> Complete the following checklist: <br /> ❑ Yes ❑ No" Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> ❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> © Yes ❑ No" Was accuracy of system product level readings tested? <br /> ❑ Yes ❑ No* Was accuracy of system water level readings tested? <br /> Yes ❑ No* Were all probes reinstalled properly? <br /> CJ 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 /> G. LINE LEAK DETECTORS (LLD): Ll Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> ❑ Yes ❑ No* For equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance? <br /> ❑ NIA (check all that apply) Simulated leak rate: ■ 3 g.p.h.; ❑ 0.1 g.p.h.; ❑ 0.2 g.p.h. <br /> ❑ Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> ❑ 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 /> ❑ NIA - -- <br /> ❑ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ❑ NIA <br /> ❑ Yes Q No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> ❑ NIA or disconnected? — — <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 /> L] Yes EJNo' Were all items on the equipment manufacturer's maintenance checklist completed? _ J <br /> " In Section N below, describe how and when these deficiencies were or will be corrected. <br /> H. COMMENTS <br /> r`2619 Walton Engineering,Inc. <br /> Page 3 of 3 <br />