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Monitoring System Certification-Page 3 of 3 <br /> Site Address: 4219 Morada Ln.@. Date of Testing/Servicing: 7122106 <br /> F. In-Tank Gauging/SIR Equipment: o 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 following checklist: <br /> CK Yes 0 No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br /> M Yes 0 No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> R Yes 0 No* Was accuracy of system product level readings tested? <br /> R Yes O No* Was accuracy of system water level readings tested? <br /> R Yes 0 No* Were all probes reinstalled properly? <br /> M Yes o 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): O Check this box if LLD's are not installed. <br /> Complete the following checklist: <br /> •Yes 0 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:M 3 gp.h.(l.); 0 0.1 g.p.b.(2.); 0 0.2 g.p.h.(2.). <br /> Notes: 1. Required for equipment start-up certification peril annual certification. <br /> 2. Unless mandated by local agency, certification required only for electronic LLD start-up. <br /> •Yes 0 No* Were all LLD's confirmed operational and accurate within regulatory requirements? <br /> Q Yes 0 No* Was the testing apparatus properlycalibrated? <br /> 0 Yes 0 No* For mechanical LLD's,does the LLD restrict product flow if it detects a leak? <br /> li N/A <br /> R Yes 0 No* For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak? <br /> 0 N/A <br /> Q 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 /> R Yes 13 NO For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system <br /> 0 N/A mal unctions or fails a test? <br /> R Yes 13 No* For electronic LLD's,have all accessible wiring connections been visually inspected? <br /> O N/A <br /> not Yes 0 No* j Were all items on the equipment manufacturer's maintenance checklistcompleted? <br /> •In Section H below,describe how and when these deficiencies were or will be corrected. <br /> IL Comments: <br /> 1 <br /> i <br />