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MONITq&ING SYSTEM CERTIRVATION CERTIFICATION / TEST DATE: October 17, 2011 Al. FACILITY A2. OWNER Name 7-Eleven Market#2368/Store#32190 Name 7-Eleven, Inc Address 4943 South State Route 99,Stockton,CA 95206 Address P.O. Box 711, Dallas,TX 75221 Phone# 209-939-0679 Phone# 805-523-2949 Contact Stephen Boyd Contact Stephen Boyd F. IN-TANK GAUGING /SIR EQUIPMENT: ■ 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 gaugung equipment is used to perform leak detection monitoring. Complete the following checklist: ❑ Yes ❑ No* Has all Inputwiring 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 LLDs are not installed. Complete the following checklist: ■ 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 rate: ■ 3g.p.h.; ❑ 0.1 g.p.h.; ❑ 0.2 g.p.h. ■ Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? ■ Yes ❑ No* Was the testing apparatus properly calibrated? ❑ Yes ❑ No* For mechanical LLDs,does the LLD restrict product Flow if it detects a leak? ■ NIA ■ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? ❑ N/A ■ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off If any portion of the monitoring system is disabled ❑ N/A or disconnected? ■ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions ❑ N/A or fails a test? ■ Yes ElNo* For electronic LLDs,have all accessible wiring connections been visually Inspected? ElN/A ■ Yes ElNo* 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 t 2011 Walton Engineering,Inc. Page 3 of 3