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P Aoring System Certification <br /> Site Address: 2448 W KETTLEMAN LN Date of Testing/Service: 06/06/2005 <br /> 0 LOWER SACRAMENTO RD <br /> F. In-Tank Gauging/ SIR Equipment ❑ Check this box if tank gauging is used only for inventory control. <br /> ❑ 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 perform leak detection monitoring. <br /> Complete the following checklist: <br /> Yes ❑NoHas all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> Yes F]No' Were all tank gauging probes visually inspected for damage and residue buildup? <br /> Yes F-]No• Was accuracy of system product level readings tested? <br /> Yes F-1 No Was accuracy of system water level readings tested? <br /> Yes ❑No• Were all probes reinstalled properly? <br /> Yes ❑No• Were all items on the equipment manufacturers'maintenance checklist completed? <br /> 'In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors (LLD) : Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> Q Yes E]No <br /> For equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance? <br /> ` N/A Check all that aPPIY)Simulated leak rate: Q 3 9Rh 0 0.1 9-P-h E]0.2 9Ph <br /> M Yes ❑No Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> X Yes ❑No' Was the testing apparatus properly calibrated? <br /> Yes E]No ❑N/A For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> ❑Yes ❑No` ®N/A For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ❑Yes ❑No• ❑x N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> ❑Yes <br /> —]No• X N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> ❑Yes ❑No' ❑X N/A For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> ElYes ❑No` Were all items on the equipment manufacturers'maintenance checklist completed? <br /> 'In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> Page 3 of 3 Based on CA form dated 03/01 <br />