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,JUL-11-2011 10:49 Service Station Systems 408 938 8888 P.04 Monitoring System Certification-Page 3 of 3 Site Address: 3505 Navy Dr. Date ofTesting/Servicing: 6/27111 F. In-Tank Gauging/SIR Equipment: 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 fall ing checklist.. O Yes 13 NO Has all input wiring been inspected for proper entry and termination, including testing for ground faults? 0 Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? ❑ Yes ❑ No* Was accuracy of system product level readings tested? 0 Yes ❑ No* Was accuracy of system water level readings tested? ❑ Yes 0 No* Were all probes reinstalled properly? 0 Yes 1 0 No* I 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. C. Line Leak.Detectors(LLD): J Check this box if LLD's are not installed. Com tete the following checklist: ❑ Yes 0 No* For equipment start-up or annual equipment certification was a leak simulated to verify L1..13 performance? ❑ N/A (Check all that apply) Simulated leak rate: ❑ 3 g.p.h. (1.); 0 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 a enc ,certification required only for electronic LLD start-up. 0 Yes p Nos Were all LLD's confirmed operational and accurate within regulatory requirements? 1J Yes ❑ No* Was the testing apparatus ro erl calibrated? ❑ Yes 0 No* For mechanical LLD's,does the LLD restrict product flow if it detects a leak? 0 N/A - 0 Yes ❑ No* For electronic LU)'s,does the turbine automatically shut off if the LLD detects a leak? ❑ N/A 0 Yes ❑ No* For cicetronic LLD's,does the turbine automatically shut off if any portion of the monitoring system is disabled ❑ N/A or disconnected? 0 Yes ❑ 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? ❑ Yes 0 No* For electronic LLD's,have all accessible wiring connections been visually inspected? 0 N/A 0 Yes ❑ No* I 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. Tank monitored by a sensor.