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FEB -13-2009 19:37 Service Station Systems <br />Monitoring System Certification -1 3 of 3 <br />408 938 eeee P.05 <br />Site Address: 6425 N. Pacific Ave. Central Ct. Date of Testing/Servicing: 1114/09 <br />F. In - Tank Gauging / SIR Equipment: <br />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 followinv eheeklkte <br />0 Yes <br />0 No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />0 Yes <br />0 No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />0 Yes <br />❑ No* <br />Was accuracy of system product level readings tested? <br />0 Yes <br />❑ No* <br />Was accuracy of system water level readings tested? <br />0 Yes <br />❑ No; <br />Were all probes reinstalled properly? <br />0 Yes 0 No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />w. -& wmc uc.gounus 3 were or win ue correctea, <br />G. Line Leak Detectors (LLD): 0 Check this box if LLD's are not installed. <br />Complete the fallnwinv ehecklicre <br />e Yes <br />0 No* <br />For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? <br />0 N/A <br />(Check all that apply) Simulated leak reate: R 3 g.p.h. (1.); 0 0.1 g.p.h. (2); 0 0.2 g.p.h. (2). <br />Notes: I. Required for equipment start-up certification and annual certification. <br />2. Unless mandated by local agency, certification required only for electronic LLD start-up. <br />M Yes <br />0 No* <br />Were all LLD's cortfirmed operational and accurate within re ttlato requirements? <br />is Yes <br />ENO <br />Was the testis apparatus properly calibrated? <br />Cl Yes <br />0 No* <br />For mechanical LLD's, does the LLD restrict product flow if it detects a leak? <br />M N/A <br />11 Yes <br />t] No* <br />For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak? <br />0 N/A <br />18 Yes <br />0 No* <br />For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />0 N/A <br />or disconnected? <br />• Yes <br />El No* <br />For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system <br />0 N/A <br />malfunctions or fails a test.) <br />• Yes <br />0 No* <br />For electronic LLD's, have all accessible wiring connections been visually inspected? <br />❑ N/A <br />R Yes <br />0 N/A <br />Were all inims on the equipment manufacturer's maintenance checklist completed? <br />x to section ri below, describe how and when these deficiencies were or will be corrected. <br />IL Comments: Regular has two PLLD's <br />