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64/18/2003 08:18 408971013r- SSS INC ^� PAGE 04 <br /> Monitoring System CertificAtiun-1!',( of 3 1 <br /> Site Address; 7990 Sacramento Rd. Hammer Lane Date ofTestinf9 <br /> /Servicing. 02l99103 <br /> F. In -Tank Gauging/ SIR Equipment: ❑ Check this box if tank gauging is used only for inventory control. <br /> ❑ Clicek this box if no tank gauging or SIR equipment is installed. <br /> This section mast be completed if in-tank ;dosing equipmti.t is used to perform leak detectityi, monit©.ring- <br /> r1letofollowin checklist: <br /> *,* Has all input.wing bccn inspected fo, f)c uper entry and termination, including testing for ground faulrs?o* Were all tank gauging probes visually inspected for dama�=e and residue buildup'.o* W$'a accuracy of system product level readings tcstt;d? <br /> ®Yes ❑ No* Was accuracy of system water level readings tested? <br /> I$Yes ❑ No* Wer, all Prabrs reinstallcci properly? <br /> ®Yes ❑No* Were all itelais on the equipment manufacturer's maintenance checklist completed? <br /> *In Section H below,deseriho.how and when those detieicncics tiwerc or will bu corrected. <br /> G. Line Leak Detectors (LLD): 0 Check this box if LLD's are not installed <br /> Con, lcte the foll(a) Ving checklist: <br /> BI Yes ❑ No* For equipment starr-tip or annual equipme31t certification was a leak su,iulatccl to verify LLl.1 pertbrmance? <br /> Ll N/A (Cheek all thur.app4y) Simulated leak reatc_ 01 3 g-p.h. (1.); El0.1 9.p-b. (2, ; ❑ 0.2 <br /> g.p.lx.(2.). <br /> Notes; 1. Required for equipment start-up certification and annual certification. <br /> I. UnlesS mandated by local agency, certification required only for electronic LLD start-u . <br /> z Yes ❑ No* Were all LLD's confirmed operational and accurate within regulatory requirements? <br /> (Yes ❑ No's Was the testinu a aratu;.pro crly calibrated? <br /> ❑Yes ❑ No* For mechanical LLD's, does the LLD restrict product flow if it detects a leak? <br /> ® N/A, <br /> R Yes ❑ NO For electronic LLD's,does the turbine automatically shut off if the LLD detects a leak? <br /> ❑ NIA <br /> ®Yc°c ri Noy` l:o,.ciactrunic LLD's,does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> ❑ N/A or disconnected'? <br /> W Yes ❑ No* For electronic LLD's,does the h,rhine a,,to„laticall),shut off if any portion of th „ituci„g system <br /> o N/A malfunctions or fails a test? <br /> 09 Yes ❑ No* Por clectron.ic LLD's,have all accessible wiring connections been visually inspected? <br /> ❑ N/A <br /> Yes ❑NO Were all items on the equiptilent.manufacturer's maintenance checklist completed? <br /> *In Section H belmv,deseribc how and when these deficiencies were or will be corrected. <br /> H. Comments- <br />