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04/16/2004 10:59 1209365 TANKNOLOGY PAGE 05 <br /> Monitoring System Certification <br /> SiteAddress; 2905W, BENJAMIN HOLT Date of TestIng/Servica, 03129/2004 <br /> @ 1-5 <br /> F. In-Tank Gauging I SIR Equipment ❑ 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 following checklist: <br /> El Yes 0No 0 Has all input wiring been Inspected for proper entry and termination,including testing for ground faults? <br /> E]Y" [:]No- Were all tank gauging probes visually inspected for damage and residue buildup? <br /> Eyes E]No- Was accuracy of system product level readings tested? <br /> Yes 0 No Woe accuracy of system water level readings tested? <br /> P 1 Yes ON.• Were all probes reinstalled properly? <br /> EX Yes L]No Were all items on the equipment manufacturers'maintenance checklist completed? <br /> .❑ <br /> In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors (LLD) Check this box <br /> Complete the following checklist: <br /> For equipment start-up or annual equipment certificatlon,was a leak simulated to verify LLD performance? <br /> Ej Yes ONo* [3 NIA (Check all that apply)Simulated leak rate; E 3 g,p,h 0 0.1 g.p.h E]0.2 9-p-h <br /> 7X.Yes ❑No-- Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> 71 Yes ©No* Was the testing apparatus properly calibrated? <br /> El Yea []No" N/A For mechanical 1-1-0s,does the LLD restrict product flow if it detects a leak? <br /> Yo. [:IN.- 0 N/A For electronic LLDs,does the turbine automatically shut off if the 1.1-1)detects a leak? <br /> Yes 0No- ❑NIA For electronic LLDs,C108B the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> E]Yes EjN0^ WA For electronic LLDs,does the turbine automatically shut off If any portion of the monitoring system malfunctions or fails a test? <br /> ElYes E]No• F-1 N/A For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> IL91 yes EjNc Were all Items an the equipment manufacturers'maintenance checklist completed? <br /> In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments, <br /> Page 3 of 3 Based on CA form dated 03/01 <br />