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Site Address: 2186: 3212 N CALIFORNIA )CKTON, CA 95204 Dat Testing(Servicing___ toI1z(0�_ F. In -Tank Gauging /SIR Equipment -ZZ, Check this box if tank gauging is used only for inventory control. SCheck this box if no tank gauging or SIR equipment is installed. This section must be completed if in -tank gaug-ng equipment is used to perform leak detection monitoring. Complete the foilow klist: _ Yes No* Has all input�g_b_p` spected for proper entry and terminaL+.on, includingttesW �for�6urid faults? ` v__ I WfwT_wI VAT- it ♦a«t. A fni, AArn Aae and residue buauuuA? i yes .� Now .. --- -----o--�-vim - - — Was accuracy of system product level rea ested? Yes No* Was accuracy of system waterlevel readings test . I Yes Now Were all probes reinstalled properi Yes No* Were all items .meat manufacturer's maintenance checklist comple * In the Section H, below, describe how and when these dericxencies were or wau oe correeao a. G. Line Leak Detectors (LLD): M CheckthisboxifLLDs are not installed. l,em a4R Yes a/IC AULMU tr Now' bs &. For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? NIA (Check all that apply) Simulated leak rate: M 3 g.p.h.l; Iff 0.1 g.p.h 2; IN. 0.2 g.ph? Notes: 1. Required for equipment start-up certificationgiad annual certification. 2. Unless mandated by local agency, certification required only for electronic LLD start-up. Yes No* Were allLLDs confirmed operational and accurate withinregulatoryrequiremer_ts? Yes Now Was the testing apparatus properly calibrated? Yes No* For mechanicelLLDs, does the LLD restrict product flow if it detects aleak? NIA Yes No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a.leay. NIA Yes No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled NIA or disconnected? Yes Now For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions NIA or fails a test? Yes No* For electronic LLDs, have all accessible wiring connections been visually inspected? NIA Yes Now Were all items on the equipment manufactauer's maintenance checklist completed? * In the Section H, below, deserve now ana when mese QellcaeaLr65 rron Vr wawa UC cVaio%,Ma. H. Comments: i 1 s � i I � Page 3 of 3 03JO1