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JUL-24-2006 16:36 Service Station Systems 408 838 8888 P.04 <br /> Monitoring System Certification-Pn0of3 <br /> 1 <br /> Site Address: 4219 Morada Ln. _ ^� Date of Tcsting/Servicing: 7/22/08 <br /> F. In-Tank Gauging/SIR Equipment! ❑ Check this box if tank gauging is used only for inventory control. <br /> ❑ Check this box if no tank gauging or Slit equipment is installed. <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. <br /> Com lete the following checklist; <br /> ix Yes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br /> M Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> l8 Yes ❑ No* Was accuracy of system product level readings tested? <br /> a Yes ❑ No# Was accuracy of system water level readings tested? <br /> 11 Yes 0 NO Were all probes reinstalled properly? <br /> M Yes Q No* Were all items on the equipment manufacturer's 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): p Check this box if LLD's are not installed. <br /> Com lete the fullo, ing checklist., <br /> 18 Yes ❑ No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? <br /> 0 N/A (Check all that apply) Simulated leak reate:l8 a g.p,h. (1.); 0 0.1 g.p.h.(2.); ❑ 0.2 g,p.h.(2.). <br /> Notes: I_ Required for equipment start-up certification and annual certification. <br /> 2. Unless mandated by local agency, certification required on! for electronic LLD start-up. <br /> 11'Yes ❑ No* Were all LLD's confirmed operational and accurate within regulatory requirements? <br /> 18 Yes ❑ No* Was the testing apparatus properly calibrated? <br /> ❑ Yes ❑ No* For mechanical LLD',,, does the LLD restrict product flow if it detects a leak? <br /> tS NIA <br /> CK Yes 0 No* For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak? <br /> ❑ N/A <br /> M Yes ❑ No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> N/A or disconnected? <br /> Ix Yes ❑ No* For electronic LLD's.does the turbine automatically shut off if any portion of the monitoring system <br /> ❑ N/A malfunctions or fails a test? <br /> lS Yes ❑ No* For electronic LLD's, have all accessible wiring connections been visually inspected? <br /> q N/A <br /> IL M"Yes I ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> * In Section H below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments- <br />