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04/16/2004 10:59 1209365 TANKNOLOGY PAGE OB <br /> Monitoring System Certification <br /> Site Address: 2905 W. BENJAMIN HOLT Date of TestIng/Sarvioe; Q3Q912Q04 <br /> @ 1-5 <br /> F. In-Tank Gauging/SIR Equipment Check this box if tank gouging 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 /> Yes MISIVI Has all Input wiring been inspected for proper entry and termination,including tasting for ground faults? <br /> Yes []No• Were all tank gauging probes visually Inspected for damage and residue buildup? <br /> E Yes ON, Was accuracy of system product level readings tested? <br /> El Yms <br /> LJNO Was accuracy of system water level readings tested? <br /> Fx_ yes ®No. Were all probes reinstalled properly? <br /> ElYes Ej No. Were all items on the equipment manufacturers'maintenance checklist completed? <br /> *In the Section H,below,describe how and when these deficiencies were or will be corrected, <br /> G. Line Leak Detectors(LLD) E] Check this box if LLDs are not installed, <br /> complete the following checklist. <br /> For equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance? <br /> ED Yes ❑No- CJN/A (Check all that apply)Simulated leak rate; E 3 g.p.h[]0.1 g.p.h [:]0.2 g.p.h <br /> FX1 Yes ❑No- Were all LLI)s confirmed operational and accurate within regulatory requirements? <br /> J-.A- <br /> .MX Yes ONO' Was the testing apparatus properly calibrated? <br /> ®Yea I E]No, [XD N/A For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> I'm <br /> L!2j Yes [:]No- [D NIA For electronic LLD%does the turbine automatically shut off if the LLD dotacta a leak? <br /> Y.. MN,- ❑N/A For elactronir.LLDs,does the turbine automatically shut off If any portion of the monitoring system is disabled or disconnected? <br /> 21 Yes EJN*- NIA For electronIc LLDs,does the turbine automatically shut off if any portion of the monitoring system Malfunctions or falls a test? <br /> X Yes ❑No* EIN/A For electronic LLD$,have all accessible wiring con naction s been visually inspected? <br /> In Yes I ONO'. .Were all items on 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 Bared on CA form dated 03/01 <br />