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Monitoring System Certification <br /> 0 <br /> Site Address: 2725 COUNTRY CLUB BLVD Date of TestinglService: 02/2412011 <br /> F. In-Tank Gauging 1 SIR Equipment <br /> 0 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 /> 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 /> E Yes ❑No Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> ❑X Yes ❑'No• Were all tank gauging probes visually inspected for damage and residue buildup? <br /> EYes ❑No' Was accuracy of system product level readings tested? <br /> F]Yes I F—]No Was accuracy of system water level readings tested? <br /> X Yes ❑No• Were all probes reinstalled properly? <br /> EYes ❑No* Were all items on the equipment manufacturers'maintenance checklist completed? <br /> 'In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors (LLD) : ❑ Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> For equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance? <br /> ®Yes ❑No ❑NIA (Check all that apply)Simulated teak rate: Q 3 g.p.h ❑0.1 g.p.h ❑0.2 g.p.h <br /> Yes [:]No. <br /> No• Were all i confirmed operational and accurate within regulatory requirements? <br /> X Yes ❑No. Was the testing apparatus properly calibrated? <br /> ®Yes ❑No' ❑NIA For mechanical Li does the LLD restrict product flow if it detects a leak? <br /> ❑Yes ❑No* 0 NIA For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ❑Yes ❑No• ❑X N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> ❑Yes ❑No• Q NIA For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> ❑Yes ❑No* Q NIA For electronic LLDs, have all accessible wiring connections been visually inspected? <br /> LJ Yes ❑No Were all items on the equipment manufacturers'maintenance checklist completed? <br /> * In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> Page 3 of 3 Based on CA form dated 03108 <br />