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JUL-01-2011 09:32 Service Station Systems 408 938 8888 P.05 Nionitoring System Certification-Page 3 of 3 Site Address: 2448 W, Kettleman Ln. Date of Testing/Servicing: 5131/11 F. In-Tank Ganging/SIR Equipment; W Check this box if tank gauging 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. Com lete the folio ing checklist: ❑ Yes ❑ No* I 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? 4 Yes ❑ No* Was accuracy of system water level readines tested? ❑ Yes ❑ No* Were all probes reinstalled properly? ❑ Yes Q 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. G. Line Leak.Detectors(LLD). ❑ Check this box if LLD's are not installed. Com fete the folio ina checklist: ® 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 rate: ® 3 g,p.h. (1.); ❑ 0.1 g.p.h.(2.); ❑ 0.2 g.p.h• (2). Notes: 1. Required for equipment start-up certification LnA annual certification. 2. Unless mandated by local as ency,certification required only for electronic LLD start-tip. ® Yes ❑ No* Were all LLD's confirmed operational and accurate within regulatory requirements? 11 Yes ❑ No* Was the testing apparatus properly calibrated? a Yes ❑ No* For mechanical LLD's,docs the LLD restrict product flow if it detects a teak? ❑ N/A ❑ Yes ❑ No* For electronic L1,O's,does the turbine automatically shut off if the LLD detects a leak? ® N/A ❑ Yes ❑ No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system is disabled 0 N/A or disconnected'? ❑ Yes ❑ No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system 8 N/A malfunctions or fails a test? ❑ Yes ❑ No* For electronic LLD's,have all accessible wiring connections been visually inspected? 0 N/A ® 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.•