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L12horing System Certification <br /> Site Address: 3425 TRACY BLVD Date of T ng/Se ' : 01/11/2006 <br /> F. in-Tank Gauging/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 folloiNing checidleb- <br /> E]Yes ❑No• Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> ®Yes ❑No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ®Yes ❑No* Was accuracy of system product level readings tested? <br /> ®Yes ❑No* Was accuracy of system water level readings tested? <br /> ElYes ®No* Were all probes reinstalled properly? <br /> Q Yes 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) : ❑ 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 /> x❑Yes ❑No* ❑N/A (Check all that apply)Simulated leak rate: ❑ 3 g.p.h®0.1 g.p.hE]0.2 g.p.h <br /> X Yes ❑No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> x Yes ❑No* Was the testing apparatus property calibrated? <br /> ❑Yes [:]No* ®N/A For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> M Yes ❑No* ❑N/A For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ❑Yes ❑No* ❑N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> M Yes ❑No* ❑N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> ®Yes []No- ❑N/A For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> MYes ❑No* Were all items on the equipment manufacturers'maintenance checklist completed? <br /> 'In the Section H.below,describe how and when View deficiencies were or will be corrected. <br /> H. Comments: <br /> Page 3 of 3 Based on CA form dated 03101 <br />