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RUG-12-2010 09:11 Service Station Systems 408 938 8888 P.04 <br /> Monttoring System Certification-Pa_ of 3 <br /> Site Address: 6426 N. Pacific Ave. Date of Testing/Servicing: /v <br /> F. In -Tank Gauging/SIR Equipment: 0 Check this box if tank gauging is used only for inventory control. <br /> 0 Check this box if no tank gauging or SIR equipment is installed. <br /> This section must be completed if in-tank gauging equipment is a to perform leak detection monitoring. <br /> Complete the following checklist: <br /> ❑ Yes 0 No* Has all input wiring been inspected for pr er entry and termination, including testing for ground faults? <br /> 0 Yes p No* Were all tank gauging probes visual) aspected for damage and residue buildup? <br /> ❑ Yes Cl No* Was accuracy of system producpKvel readings tested? <br /> 0 Yes 0 No* Was accuracy of system w level readings tested? <br /> 0 Yes 0 No* Were all probes reins ed properly? <br /> 0 Yes ❑ No* Were all items on th6 equipment manufacturer's maintenance checklist completed? <br /> * In Section H below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors (LLD): ❑ Check this box if LLD's are not installed. <br /> Complete the following checklist: <br /> Q Yes 0 No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? <br /> 0 N/A (Check all that apply) Simulated leak reateks 3 g.p.h.(l.); ❑ 0.1 g.p.h. (2.); ❑ 0.2 g.p.h.(2.). <br /> Notes: 1. Required for equipment start-up certification rad annual certification. <br /> 2. Unless mandated by local agency, certification required only for electronic LLD start-up. <br /> B Yes 0 No* Were all LLD's confirmed operational and accurate within regulatory requirements? <br /> 6 Yes ❑ No* Was the testing apparatus properly calibrated? <br /> ❑ Yes 0 No* For mechanical LLD's,does the LLD restrict product flow if it detects a leak? <br /> a0 NIA <br /> 0 Yes 0 No* For electronic LLD's,does the turbine automatically shut off if the LLD detects a leak? <br /> 0 NIA <br /> 4-Yes 0 No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> C N/A or disconnected? <br /> MYes 0 No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system <br /> ❑ N/A malfunctions or fails a test? <br /> Yes D No* For electronic LLD's,have all accessible wiring connections been visually inspected? <br /> Cl N/A <br /> rF Yes 0 No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> * In Section H below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments, <br /> TOTAL P.04 <br />