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FEB -04-2009 20:21 Service Station Systems Monitoring System Certification - Pr '; of 3 408 938 8888 P.05 Site Address: 1804 West 11Th. Street L Corral Hallow Date of Testing/Servicing: 12/29/08 F. In - Tank Gauging / SIR Equipment: l P Check this box if tank gauging is used only for inventory control. ❑ Chock 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 teak detection monitoring. Cmmnlett- the fallnwina rherklict- Yes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? Yes ❑ No* Was accuracy of system product level readings tested? l?Yes ❑ No* Was accuracy of system water level readings tested? P Yes a No. Were all probes reinstalled property? Yes ❑ No* iWere 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. II 1pYes ❑ NO For equipment start-up or annual equipment certification w a leak simulated to verify LLD performance? ❑ N/A (Check all that apply) Sitnulated leak reate:1� 3 g.p_h ); ❑ 0.1 g.p.h. (2.); ❑ 0.2 g.p_h. (2.). Notes: 1. Required for equipment start-up eerti tion and annual certification. 2. Unless mandated by local a encu rtification required only for electronic LLD start-up. 5PYes ❑ No* Were all LLD's confirmed operational and curate within regulatory requirements? Yes ❑ No* Was the testing apparatus properly calf ated? ❑ Ycs ❑ No* For mechanical LLD's, does the L restrict product flow if it detects a leak? N/A $ Yes ❑ No* For electronic LLD's. does turbine automatically shut off if the LLD detects a leak? ❑ N/A Oji Yes [I No* For electronic LLD's, oes the turbine automatically shut off if any portion of the monitoring system is disabled p N/A or disconnected? FFYes ❑ No* For electronic LA's, does the turbine automatically shut off if any portion of the monitoring system ❑ N/A malfunctions Vfdils a test'' ibYes ❑ No* Por electro c LLD's, have all accessible wiring connections been visually inspected? ❑ N/A Yes ❑ No* Were, 1 items on the equipment manufacturer's maintenance checklist completed? * In Section H below, discribe bow and when these deficiencies were or will be corrected. H. Comments: ' I ,. J