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.ZUL-02-2010 16:52 Service Station Systerns 408 938 8888 P.06 Monitoring Syatem Certification - Pat, A3 Site Address: 1987 West 11Th. Street Date of Testing/Servicing: 612110 F. In - Tank Gauging / SIR Equipment: Ix Check this box if tank gaugin,2 is used only for inventory control. Cl Check this box if no tank gauging or SCR equipment is installed. This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. ❑ Yes 0 No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ❑ Yes 0 No* Were all tank gauging probes visually inspected for damage and residue buildup'? ❑ Yes 0 No* Was accuracy of system product level readings tested? ❑ Yes o Yes a No ❑ Noy` Was accuracy of system water level readings tested? Were all probes reinstalled properly? ❑ Yes ❑ Noy` Were all items on the equipment manufacturer's maintenance checklist completed'? * in Section H below, describe how and when these deficiencies were or will ne correctea. G. Line Leak Detectors (LLD): Cl Check this box if LLD's are not installed. Comnlete the following checklist: CK Yes 0 No* For equipment start -ftp or annual cduipment certification was a leak simulated to verify LI.,D performance? ❑ N/A (Check all that apply) Simulated leak reate: ix 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, certilieation required only for electronic LLD start-up. lH Yes ❑ No* Were all LLD's confirmed operational and accurate within regulatory requirements'? ES Yes 0 No* Was the testing apparaws properly calibrated? ❑ Yes ❑ No* For mechanical LLD's, does the LLD restrict product flow if it detects a leak? B N/A E3 Yes Q No* For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak? ❑ N/A E8 Yes ❑ No* For electronic LLD's. does the turbine automatically shut off if any portion of the monitoring system is disabled ❑ N/A or disconnected? tg Yes ❑ Nil* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system 0 N/A malfunctions or fails a test? Ix Yes ❑ No* For electronic LLD's, have all accessible wiring connections been visually inspected? ❑ N/A EZ 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 ne correctea. H. Comments: