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Aitoring System Certification <br /> Site Address: 3633 DUCK CREEK DR. @ Date of Testing/Service: 10/24/2002 <br /> OFF HWY 99 @ MARIPOSA RD <br /> F. In-Tank Gauging 1 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 gauging 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 /> 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 /> G. Line Leak Detectors (LLD) : ❑ Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> ❑X Yes [:]No* ❑NIA <br /> For equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance? <br /> (Check all that apply)Simulated leak rate: le_i 3 g.p.h ❑0.1 g.p.hE]0.2 g.p.h <br /> X Yes ❑No Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> ❑x Yes ❑No' Was the testing apparatus properly calibrated? <br /> M Yes ❑No• ❑NIA I For mechanical LLDs,does the LLD restrict product Plow if it detects a leak? <br /> Yes ❑No' ®NIA For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ❑Yes ❑No' ®NIA For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> ❑Yes ❑No' 0 NA For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> ❑Yes ❑Ne' NIA For electronic LLDs, have all accessible wiring connections been visually inspected? <br /> 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 /> Michael Levesque <br /> VR Cert#000-00-5505 <br /> Tanknology Contractor Lic#743160 <br /> page 3 of 3 <br />