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•Monitoring System Certification Site Address: 4943 S. KINGSLEY MKT 2237 F. In -Tank Gauging / SIR Equipment Date of Testing/Service: 01/17/2007 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: G. Line Leak Detectors (LLD) : Complete the following checklist: ❑ Check this box if LLD$ are not installed. Q Yes E] No' Has all input wiring been inspected for proper entry and termination, including testing for ground faults? For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) Simulated leak rate: x❑ 3 g.p.h ❑ 0.1 g.p.h ❑0.2 g.p.h X Yes Were all tank gauging probes visually inspected for damage and residue buildup? XON, Was accuracy of system product level readings tested? ❑No • Was accuracy of system water level readings tested? ❑ Yes ❑No • Were all probes reinstalled propedy? For mechanical LLDs, does the LLD restrict product flow if it detects a leak? Q Yes Were all items on the equipment manufacturers' maintenance checklist completed? * In the Section H. belowdeccrihP hr,w PM .m- e:.e..,. G. Line Leak Detectors (LLD) : Complete the following checklist: ❑ Check this box if LLD$ are not installed. Q Yes E] No' ❑ WA For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) Simulated leak rate: x❑ 3 g.p.h ❑ 0.1 g.p.h ❑0.2 g.p.h X Yes ❑ No • Were all LLDs confirmed operational and accurate within regulatory requirements? x Yes ❑No • Was the testing apparatus properly calibrated? ❑ Yes ❑No • 0 NIA For mechanical LLDs, does the LLD restrict product flow if it detects a leak? Q Yes ❑No • ❑ NIA For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? 0 Yes []No • ❑ NIA For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? QYes ❑No • ❑ N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? Yes []No• ❑ N/A For electronic LLDs, have all accessible wiring connections been visually inspected? l❑x U Yes * In the Section ❑No • H. below. Were all items on the equipment manufacturers' maintenance checklist completed? descdhw h. and whe,, rhe.. H. Comments: Page 3 of 3 Based on CA form dated 03/01