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MAR-21-2012 12:23 Service Station Systems 408 938 8888 P.OS <br /> Monitoring System Certification-Page 3 of 3 <br /> Site Address: 401 W. Kettleman Ln. Date of Testing/Servicing: 2/23/12 <br /> F. In-Tank Gauging/SIR Equipment: H Check this box if tank gauging is used only for inventory control. <br /> 13 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 /> Com late the following checklist: <br /> 0 Yes 11 No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> 0 Yes t] No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> 0 Yes 0 No* Was accuracy of system product level readings tested'? <br /> 0 Yes 0 No* Was accuracy of system water level readings tested? <br /> 0 Yes 0 No* Were all probes reinstalled properly? <br /> 0 Yes 0 No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> *In Section H below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors(LLD): 0 Check this box if LLD's are not installed. <br /> Com fete the foil in 9 checklist: <br /> H Yes 0 No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? <br /> 0 N/A (Check all that apply) Simulated leak rate: H 3 g.p.h.(1.); 13 0.1 g.p.h.(2.); 0 0.2 g.p.h.(2.). <br /> Notes: 1. Required for equipment start-up certification and annual certification. <br /> 2. Unless mandated by local.nITEX,certification required only for electronic LLD start-up. <br /> H Yes 0 No* Worc all LLD's confirmed o tional and accurate within reulat r uirements? <br /> H Yes © No* Was the testing a aratus properly calibrated? <br /> H Yes 0 No* For mechanical LLUs,docs the LLD restrict product flow if it detects a leak? <br /> E3 N/A <br /> 0 Yes 0 No* For electronic LLD's,docs the turbine automatically shut off if the LLD detects a leak? <br /> H N/A <br /> ❑ Yes 0 No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> 8 N/A or disconnected? <br /> 0 Yes 0 No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system <br /> H N/A malfunctions or fails a test? <br /> 11 Yes 0 No* For electronic LLD's,have all accessible wiring connections been visually inspected? <br /> 0 N/A <br /> Yes 0 No* 1 Were all items,on the equipment manufacturer's maintenance checklist completed? <br /> *In Section H below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: Per Inspector-probes did not need to be tested due to site having flapper varves. <br />