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Monitoring System Certification - Page 3 of 3 Site Address: 1804 West 11Th. Street @ Corral Hallow Date of Testing/Servicing: 813/09 F. In - Tank Ganging / SIR Equipment: M Check this box if tank ganging 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. Complete the following checklist: ❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? i ❑ 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 ❑ No* Was accuracy of system water level readings tested? ❑ Yes ❑ No* Were all probes reinstalled properly? ❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? j * 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: to 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: M 3 g.p h. (1.); ❑ 0.1 g.p.h. (2.); 0 02 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. M Yes ❑ No* Were all LLD's confirmed operational and accurate within regulatory requirements? I Yes ❑ No* Was the testing apparatus properly calibrated? ❑ Yes ❑ No* For mechanical LLD's, does the LLD restrict product flow if it detects a leak? M N/A M Yes ❑ No* For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak? ❑ N/A j M 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? CK Yes ❑ No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system ❑ N/A malfunctions or fails a test? Yes ❑ No* For electronic LLD's. have all accessible wiring connections been visually inspected? ❑ NIA CK 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. H. Comments: