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Monitoring System Certification-Page 3 of 3 <br /> Site Address: 4219 Moeda Ln, Data of Testlt*Servicing: 712 <br /> F. In-Tank Gauging I SIR Equipment- t] Check this box if tank gauging is used only for inventory control. <br /> 0 Check this box if no tank gauging or SIR equipment is installed_ <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. <br /> complete the followinZ cheddist: <br /> M Yes O No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> 1z Yes 0 NO Were all tank gauging probes visually inspected for damage and residue buildup? <br /> M Yes 0 No* Was accuracy of system product level readings tested? <br /> Q Yes El No* Was accuracy of system water level readings tested? <br /> M Yes 0 No* 7Wer,all probes reinstalled properly? <br /> CK Yes a No* I Were all items on the equipment manufacturees maintenance checklist completed? <br /> "In Section H below,describe how and when these deficiencies were or will be corrected. <br /> i <br /> G. Line Leak Detectors(LLD): 0 Check this box if LLD's are not installed. <br /> Complete the folul Ing checklist: <br /> •Yes 0 No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? <br /> 0 NIA (Check all that apply) Simulated leak reate:l; 3 g p.h.(1.); 0 0.1 g.p.h.(2); 0 0.2 g.p.h.(2.). <br /> Notes: 1. Required for equipment start-up certification nA annual certification. <br /> 2. Uniess mandated by local ageng,certification required only for electronic LLD start-up. <br /> •Yes 0 No* Were all LLD's confirmed operational and accurate within regutatory requireawnts7 <br /> Q Yes 0 No* Was the testis aproperly calibrated? <br /> 0 Yes D No* For mechanical LLD's,does the LLD restrict product flow if it detects a leak? <br /> a N/A <br /> M Yes D No* For electronic LLD's,does the turbine automatically shut off if the LLD detects a leapt <br /> a N/A <br /> 1z Yes 0 No* For electronic LLIYs,does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> 0 NIA or disconnected? <br /> Q Yes 13 No* For electronic LLD°s,does the turbine automatically shut off if any portion of the monitoring system <br /> 0 NIA malfunctions or fails a test? <br /> Q Yes 13 No* For electronic LLD's,have all accessible wiring connections been visually inspected? <br /> O N/A <br /> Q Yes Cl No* Were all iters on the uipment manufacturces maintenance checklist completed? <br /> " In Section H below,describe how and when these deficiencies were or will be corrected. <br /> IL Comments: <br /> I <br /> a <br />