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Monitoring System Certification-P*of 3 0 Site Address: 7910 Sacramento Rd. c@ Hammer Lane Date of Testing/Servicing: 6123104 F. In-Tank Gauging/SIR.Equipment: pg 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 ❑ No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? ❑Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? Yes ❑ No* Was accuracy of system product level readings tested? ❑Yes ❑ No* Was accuracy of system water level readings tested? ❑Yes ❑No* Were all probes reinstalled properly? ❑Yes ❑No* Were all items on the equipment manufacturer's maintenance checklist completed? *In Section H below,describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): ❑ Check this box if LLD's are not installed. Complete the following checklist: pg Yes ❑No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? ❑N/A (Check all that apply) Simulated leak reate: gg 3 g.p.h. (1.); ❑ 0.1 g.p.h. (2.) ❑ 0.2 g.p.h. (2.). Notes: 1. Required for equipment start-up certification and annual certification. 2. Unless mandated by local agency,certification required only for electronic LLD start-up. pg Yes ❑ No* Were all LLD's confirmed operational and accurate within regulatory requirements? M Yes ❑No* Was the testing apparatus properly calibrated? ❑Yes ❑No* For mechanical LLD's,does the LLD restrict product flow if it detects a leak? gg N/A pg Yes ❑No* For electronic LLD's,does the turbine automatically shut off if the LLD detects a leak? ❑N/A pg Yes ❑No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system is disabled ❑N/A or disconnected? pg Yes [I No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system ❑ N/A malfunctions or fails a test? pg Yes ❑No* For electronic LLD's,have all accessible wiring connections been visually inspected? ❑N/A pg Yes ❑No* Were all items on the equipment manufacturer's maintenance checklist completed? *In Section H below,describe how and when these deficiencies were or will be corrected. H. Comments: