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AFFORDA—TE$T 209 794 01 12 F_ 04 <br /> POB 36 20515 N SACTO. BL. Continuous Monitoring <br /> THORNTON, CA, 95686 Device Certification <br /> 209 794-0102 800 524-9087 <br /> TEST DATE <br /> SITE: <br /> OPERATOR �, p �dL� , Station# OWNER <br /> SITZ ADDREt>3 /q y, ADDRMS <br /> PBomt - PHONE <br /> MAKE ANO MODEL OF MONITORING SYSTEM <br /> Contents of Tank r„� 0,.; At, 1� <br /> Capacity of Tank y pq y �c j.2 %O/Z;! <br /> Type of Product Line: (Gravity. Suction, Pressure). O'C' <br /> INDICATE LOCATION OF THE MONITORING SENSORS TESTED BY PLACING A YES OR NO IN APPLICABLE BOX: <br /> Annular Space Sensor <br /> Sump Sensor r _ r <br /> Dispenser Containment Sensor A)0 )0 yV U <br /> Electronic Overfill/Level N q 9 COED-0 ;U t�j "'90-'o <br /> Electronic In-Line Leek Detector 0o !L9C� J{� <br /> Mechanical Line Leak Detector (� re�� t1--, <br /> to Tank Gauging Device C <br /> INDICATE THE FOLLOYNNG BY PLACING A Ye$OR NO IN APPLICABLE BOX: <br /> Does the monitoring system have audible and visual alarms? L/ �,a p� <br /> Does the turbine automatically shut-down If the system detects lt�� <br /> a leak, falls to operate or is electronically disconnected? <br /> Is the monitoring system installed to prevent unauthorized tampering? <br /> Is the monitoring system operable as per the manufacturers specifications? ��- <br /> Which continuous monitoring devices Initiate positive shut-down of the turbine? JJD�� <br /> V,e-e ae r- OD r %v O r v, rca oa li o + r <br /> .4 9q / ✓ CpH1-s•OI}'C'P` <br /> CERTIFIED TESTER'S[DO <br /> SIGNATURE OF CERTIFIM TECHNICIAN <br /> PRINTED NAME OF CERTIFIED TECHNICIAN Z' ' <br /> »<<rr <br />