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Monitoring System Certification- Pao of 3 Site Address: 1071 N. Main St. @ Louise Date of Testing/Servicing: 03/19/03 F. In -Tank Gauging 1 SIR Equipment: 1@ 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 perfonn 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? 0es ❑ 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: ®Yes ❑ No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD perfonnance? ❑ NIA (Check all that apply) Simulated leak reate: ® 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. ®Yes ❑ No* Were all LLD's confirmed operational and accurate within regulatory requirements'? x Yes ❑ No* Was the testing apparatus properly calibrated'? ❑Yes ❑ Ni o* For mechanical LLD's, does the LLD restrict product flow if it detects a leak? ® NIA ®Yes ❑ No* For electronic LLD's,does the turbine automatically shut off if the LLD detects a leak? ❑ N/A X 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? ®Yes ❑ 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`? ®Yes ❑ No* For electronic LLD's,have all accessible wiring connections been visually inspected? ❑ NIA ®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: