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E <br />Monitoring System Certification - Page 3 of 3 <br />Site Address: 401 W. Kettleman Ln. <br />F. In - Tank Gauging / SIR Equipment: <br />Date of Testing/Servicing: 2/18114 <br />w Check this box if tank gauging is used only for inventory control. <br />a 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 tne folio 12A C11CM111U. <br />la Yes o No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />E3 Yes <br />0 No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? - - ------ <br />0 - Yes <br />0 No* <br />Was accuracy of system product level readings tested? <br />0 Yes- <br />0 No* <br />Was accuracy of system water level readings tested? <br />0 Yes <br />0 No* <br />Were all probes reinstalled property? <br />[3 Yes <br />0 No* <br />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 ate not installed. <br />Com tete <br />e mio- <br />ing cifecKtist: <br />For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? <br />a — Yes <br />0 No* <br />0 N/A <br />(Check all that apply) Simulated leak rate: N 3 g.p.h. (1.); 0 0.1 g.p.h. (2.); [3 0.2 g.p.h. (2.). <br />Notes: 1. Required for equipment start-up certification 04 annual certification. <br />2. Unless mandated by local agency, certification required only for electronic LLD start-up. <br />N Yes <br />0 No* <br />Were all LLD's confirmed o2erational and accurate within regulato - re uirements? <br />0 Yes <br />[3 No* <br />Was the testi n a aratus properly calibrated? <br />Do Yes <br />_16 No* <br />For mechanical LLD's, does the LLD restrict product flow if it detects a leak? <br />0 N/A <br />o Yes <br />0 No* <br />For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak? <br />0 Yes <br />W N/A <br />0 No* <br />For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />a N/A <br />or disconnected? <br />0 Yes <br />0 No* <br />For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system <br />0 N/A <br />malfunctions or fails a test.) <br />0 Yes <br />0 No* <br />For electronic LLD's, have all accessible wiring connections been visually inspected? <br />0 N/A <br />IN Yes <br />0 No* <br />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 correctea. <br />H. Comments, <br />