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. HECEIVED Monitoring System Certification- Nage 3 of 3 MAR 18 2015 CN VIRONMENTAI_ Site Address: 3434 Manthey Road Date of Testing/ServiciAC-VT'1�9figoz,)T',r N'— F. In -"Tank Gauging/SIR Equipment: a Check this box if tank gauging is used only for inventory control. 0 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. Complete the folio ine checklist: 0 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 O No* Was accuracy of system product level readings tested? 0 Yes 0 No* Was accuracy of system water level readings tested? ❑ Yes O No* 1 Were all probes reinstalled properly? ❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed'? * In Section If 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. Complete the folio ing checklist: a Yes ❑ No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? 0 N/A (Check all that apply) Simulated leak rate: a 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 and annual certification. 2. Unless mandated by local agency,certification required only for electronic LLD start-up. a Yes ❑ No* Were all LLD's confirmed operational and accurate within regulatory requirements? a Yes ❑ No* Was the testing apparatus properly calibrated? ❑ Yes 0 No* For mechanical LLD's,does the LLD restrict product flow if it detects a leak? a N/A a Yes 0 No* For electronic LLD's,does the turbine automatically shut off if the LLD detects a leak? ❑ N/A a Yes 0 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? Cd Yes 0 No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system ❑ N/A malfunctions or fails a test? a Yes 0 No* For electronic LLD's,have all accessible wiring connections been visually inspected? 0 N/A a Yes 1 ❑ No* I Were all items on the equipment manufacturer's maintenance checklist completed? * In Section If below,describe how and when these deficiencies were or will be corrected. H. Comments: