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DEC-23-2004 12:47 SERUICE STATION SYSTEM 408 971 0135 P.05 Monitoring System Certification- -,3 of 3 ,A Site Address: 7700 Moreland Ct.@ Hwy. 99 Date of Testing/Servicing - . �/3/04 F. In-Tank Gauging/SIR Equipment: eek this box if tank gauging is used only for inventory control. v ❑ 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 following checklist; Yes ❑No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? Yes 0 No* Were all tank gauging probes visually inspected for damage and residue buildup? es ❑ 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? es 0 No* Were all items on the equipment manufacturer's maintenance checklist completed? * Section H below,describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): q Check this box if LLD's are not installed. Complete the following checklist: 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 reate:,W 3 g.p_h. (I.); ❑ 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. Yes ❑No* Were all LLD's confirmed operational and accurate within regulatory requirements? Yes a No* Was the testing apparatus properly calibrated? ❑ es —ENo* For mechanical LLD's,does the LLD restrict product flow if it detects a leak? • /A k-yes 0 No* For electronic LLD's,does the turbine automatically shut off if the LLD detects a leak? 0 N/A Yes ❑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? Yes 0 No* For electronic LIX's,does the turbine automatically shut off if any portion of the monitoring system 0 N/A malfunctions or fails a test? Yes ❑No* For electronic LLD's,have all accessible wiring connections been visually inspected? 0 N/A 119 Yes p No* Were all items on the equipment manufacturer's maintenance checklist completed? In Section H below,describe how and when these defleiencies were or will be corrected. 114. Comments: