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G Site Address: SS #6313, 1 100 S MAIN STREET. MANTECA Date of Testing/Servicing: / C F. In-Tank Gauging / SIR Equipment: Check this box if tankgauging 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. Co lete the folloNi�in checklist: ected for proper entry and termination, including testing for ground faults? Yes ❑ No* Has all input wiring been insp S ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? Yes ❑ No* Was accuracy of system product level readings tested? Yes ❑ No* Was accuracy of system water level readings tested? Yes ❑ No* Were all probes reinstalled properly? Yes ❑ No* IWere all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. Co tete the follo"1119 checklist: es ❑ No* For equipment start-up or annual equipment c�ification, was a leak simulated to verify LLD performance? ❑ N/A (Check all that apply) Simulated leak rate: C3 3 g.p.h.'; ❑ 0.1 g.p.h.2' ❑ 0.2 g.p.h.` 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. Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? es ❑ No* Was the testing apparatus properly calibrated? es ❑ No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? ❑ N/A ❑ Yes 2ZIAFor electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑ Yes ❑ For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled N/A or disconnected? ❑ Yes ❑ W For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions N/A or fails a test? ❑ Yes VIA For electronic LLDs, have all accessible wiring connections been visually inspected? es ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: PIF-Pt /}c E p f'7 < < LD - 7nDcp *V)-O5in sem, 03/01 Page 3 of 3