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JUL-04-2008 12:00 Service Station Systems 408 938 8888 P.04 <br /> Monitoring System Certification-PO of 3 <br /> Site Address: 4219 Morada Ln. Q. Date of 1"esting/Servicing; 616108 <br /> F. In-Tank Gauging/SIR Equipment: M Check this box if tank gauging is used only for inventory control. <br /> ❑ 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 /> Com lets the following checklist: <br /> 0 Yes to No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> ❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> Cl Yes ❑ No* Was accuracy of system product level readings tested? <br /> ❑ Yes 0 No* Was accuracy of system water level readings rested? <br /> 4 Yes 0 No* Were all probes reinstalled properly? <br /> D Yes 0 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), ❑ Cheek this box if LLD's are not installed. <br /> Cotta lets the follo, ing checklist; <br /> M Yes 0 No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? <br /> tl N/A (Check all that apply) Simulated leak reate:la 3 g.p.h. (1.); ❑ 0.1 g.p.h. (2.); 0 0.2 g_p.h.(2.). <br /> Notes: 1. Required for equipment start-up certification and annual certification, <br /> 2. Unless mandated by local agency,certification required only for electronic LLD start-up. <br /> M Yes 17 No* Were all LLD's confirmed operational and accurate within regulatory requirements? <br /> M Yes 0 No* Was the testin a aratus properly calibrated? <br /> 0 Yes 0 No* For mechanical LLD's, does the LLD restrict product flow if it detects a leak? <br /> is N/A <br /> M Yes 0 No* For electronic ILLD's, does the turbine automatically shut off if the LLD detects a leak? <br /> Q N/A <br /> 4C Yes 0 No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> 0 N/A or disconnected? <br /> M Yes ❑ 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 /> CK Yes 0 No* For electronic LLD's, have all accessible wiring connections been visually inspected? <br /> D N/A <br /> 1H Yes 1 R No* I Were all items on the equf ment 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 />