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FEB -04-2009 20:00 Service Station Systems <br />M6AItoring System CertMeation - Psf - 3 of 3 <br />408 938 8888 P.04 <br />Site Address: (,`. 1 r2 Date of Testing/Servicing: <br />F. In - Tank Gauging / SIR Equipment: <br />0 Check this box if tank gauging is used only for inventory control. <br />11 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 perfonn Ieak detection monitoring. <br />rnrnnlntn }he fnllnwin4 cherklict_ <br />O Yes <br />Cl No * <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />❑ Yes <br />[INo* . <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />13Yes <br />❑ No's <br />Was accuracy of system product level readings tested? <br />O Yes <br />❑ No* <br />Was accuracy of system water level readings tested? <br />n Yee <br />n V <br />Were 211 nrobes reinstalled nronerly? <br />❑Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In Section H below, describe how and when these deficiencies were or will be corrected. <br />G. Line Leak Detectors (LLD): <br />Comnkte the followine checklist: <br />0 Check this box if LLD's are not installed. <br />8'%es 0 No* For equipment start-up or annual equipment certifi 'on was a leak simulated to verify LLD performance? <br />❑ N/A (Check all that apply) Simulated leak reate; �g.p�.h. (1.); El 0.1 g.p.h. (2.); 13 0.2 g.p.h. (2). <br />Notes: 1. Required for equipment start-up certification and annual certification. <br />2. Unless mandated by local agency, certification required only for electronic LLD start-up. <br />D No* I Were all LLD's confirmed operational and accurate within regulatory requirements? <br />e�les I ❑ No* Was the testing apRaratus properly calibrated? <br />7 Yes NIA o* For mechanical LLD's, does the LLD restrict product flow if it detects a leak? <br />es ❑ No* For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak? <br />q N/A <br />es ❑ No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />0 N/A or disconnected? <br />1311'es 0 No* For electronic LLD's, does the turbine automatically shut off if any portion of the :monitoring system <br />❑ N/A malfunctions or fails a test? <br />es ❑ No* For electronic LLD's, have all accessible wiring connections been visually inspected? <br />p NIA.. <br />lt1 es ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In Section H below, describe how and when these deficiencies were or will be corrected. <br />H. Comments: <br />TOTAL P.04 <br />