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Iftnitoring System Certification <br /> Site Address: 16470 CAMBRIDGE Date of Testing/Service: 04/15/2005 <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 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 /> ❑Yes ❑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 /> ❑Yes F-1 No• Was accuracy of system product level readings tested? <br /> E]Yes ❑No• Was accuracy of system water level readings tested? <br /> Ves F-1 No• Were all probes reinstalled properly? <br /> ❑Yes 1 0 N•I Were all items on the equipment manufacturers'maintenance checklist completed? <br /> •In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors (LLD) : ❑ Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> For <br /> Q Yes ❑No• ❑N/A (Check ll that apply)Simulated annualment start-up or equipment <br /> Ira e: E] 3 g p h❑0.1 g.p.h simulated <br /> ❑g.2 g.p,h�nfy LLD performance? <br /> x Yes ❑No• Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> x Yes ❑No• Was the testing apparatus properly calibrated? <br /> ❑Yes []No• ❑MA For mechanical LLDs,does the LLD restrict product Bow if it detects a leak? <br /> ❑Yes ❑No• ®MA For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ❑Yes ❑No• x❑wA For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> ❑Yes ❑No• ❑X MA For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> ❑ves ❑No• 0 wA For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> MYes ❑No• Were all items on the equipment manufacturers'maintenance checklist completed? <br /> In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> Page 3 of 3 Based on CA form dated 03/01 <br />