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MONIT(&ING SYSTEM CERTIFWATION <br /> CERTIFICATION / TEST DATE: March 5, 2010 <br /> Al. FACILITY A2. OWNER <br /> Name 7-Eleven Market#2368/Store#32190 Name 7-Eleven, Inc <br /> Address 4943 South State Route 99,Stockton,CA 95206 Address P.O.Box 711,Dallas,TX 75221 <br /> Phone# 209-939-0679 Phone# 805-523-2949 <br /> Contact Jay Stemley Contact Jay Stemley <br /> F. IN-TANK GAUGING I 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 /> r <br /> LtDYes ❑ No" Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> ❑ No" Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ❑ No" Was accuracy of system product level readings tested? <br /> ❑ No" Was accuracy of system water level readings tested? <br /> ❑ No' Were all probes reinstalled properly? <br /> ❑ No* Were all items on the equipment manufacturers 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): ❑ Check this box if LLDs are not installed. <br /> Complete the following checklist: _ <br /> 0 Yes ❑ No* For equipment start-up or annual equipment certification,was a leak simulated to verify LL1perfoman <br /> ❑ N/A (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 property 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 ❑ No' For electronic LLDs,does the turbine automatically shut off If any portion of the monitorinNIA or disconnected? <br /> ■ Yes ❑ No" For electronic LLDs,does the turbine automatically shut off N any portion of the monitorin <br /> ❑ NIA or fails a test? <br /> ■ Yes ❑ No' For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> ❑ NIA <br /> ■ Yes ❑ No* Were all Items on the equipment manufacturers maintenance checklist completed? <br /> In Section H below, describe how and when these deficiencies were or will be corrected. <br /> H. COMMENTS <br /> 2006 Walton Engineenng,Inc. <br /> Page 3 of 3 <br />