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SEP -24-2087 13:56 Service Station Systems Monitoring System Certification - F 3 of 3 Site Address:_ 1804 West 11Th. Street & Corral Hallow F. In - Tank Gauging / SIR Equipment: 408 938 8888 P.05 Date of Testing/Servicing. 8/2/07 r% Check this box if tank gauging is used only for inventory control_ ❑ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in -tank gauging Equipment is used to perform leak detection monitoring. Com tete the foliowin checklist: ❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ,ground faults? ❑ Yes ❑ Nos Were all tank gauging probes visually inspected for damage and residue buildup? ❑ Yes ❑ No* Was accuracy of system product level readings tested? ❑ Yes 1 ❑ Noy Was accuracy of system water level readings tested? 0 Yes ❑ No* Were all probes reinstalled properly? ❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In Section H below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): ❑ Check this box if LLD's are not installed. Complete the following checklist - M Yes ❑ No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? ❑ N/A (Check all that apply) Simulated leak reate: t8 3 g.p_h_ (L); ❑ 0.1 g.p.h. (2) ❑ 0.2 g.p.h. (2). Notes: 1. Required for equipment start-up certification and annual certification. 2. Unless mandated by local agency, certification required only for electronic LLD start-up. 11 Yes ❑ No* Were all LLD's confirmed operational and accurate within regulatory requirements? 2 Yes ❑ No* Was the testing a paratus proRerly calibrated? ❑ Yes ❑ No* For mechanical LLD's, does the LLD restrict product flow if it detects a leak? to N/A M Yes ❑ No* For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak? ❑ N/A M Yes p No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is disabled ❑ N/A or disconnected? M Yes p No* For electronic LI,D's, does the turbine automatically shut off if any portion of the monitoring system ❑ N/A malfunctions or fails a test? 11 Yes ❑ No* For electronic LLD's, have all accessible wiring connections been visually inspected? ❑ N/A M Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? - it accuun n ueiuw, aescnDe now ana wnen these aeticeenctes were or will be corrected. K Comments: