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t mitoring System Certification 9 <br /> Site Address: 2908 BENJAMIN HOLT DR. Date of Testing/Service: 04/20/2006 <br /> F. In-Tank Gauging/SIR Equipment M Check this box if tank gauging is used only for inventory control. <br /> F] 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 /> E]Yes E]N,- Has an input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> []Yes FjNo- Were all tank gauging probes visually inspected for damage and residue buildup? <br /> El Yes ®No- was accuracy of system product level readings tested? <br /> E]Y.s FjNo- was accuracy of system water level readings tested? <br /> E]Yes ®No. Were all probes reinstalled properly? <br /> 0 Yes E]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) : F1 Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> Yes FFor equment start-up or annual equipmecertification,was a leak simtdated to verify performance? <br /> No- E]NIA ip <br /> (Check all that apply)Simulated leak rate:nt ff] 3 g.p.h[-]0.1 g.p.h E]0.2 g.p. LLD performan <br /> h <br /> ED Yes E]No Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> Myes nNo. Was the testing apparatus properly calibrated? <br /> Yes 101 t4o <br /> No- F1 NiA For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> M yes F]N,- Fj N/A For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> Myes nNo- F1 NtA For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> M yes []p4o- F1 N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> MX yes nt4o- n N/A For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> M-11 ❑Yes I[:J]E]NoWo- 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 /> RUL PLLD PREM VAPORLESS <br /> Page 3 of 3 Based on CA form dated 03101 <br />