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Ll Monitoring System Certification - Page 3 of 3 11 Site Address: 3725 N. Tracy Blvd. Date of Testing/Servicing: 1130114 F. In - Tank Gauging / SIR Equipment: Check this box if tank gauging is used only for inventory control. ❑ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. Complete the follo ing checklist: ❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground -faults? ❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? ❑ Yes ❑ No* Was accuracy of system product level readings tested? ❑ Yes ❑ No* Was accuracy of system water level readings tested? ❑ Yes ❑ No* Were all probes reinstalled properly? ❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checkli ompleted? * In Section H below, describe how and when these deficiencies were or will be eo acted. G. Line Leak Detectors (LLD): Check thi ox if LLD's are not installed. Comnlete the following checklist: ❑ Yes ❑ No* For equipment start-up or annual equipment c ification was a leak simulated to verify LLD performance? ❑ N/A (Check all that apply) Simulated leak rat . ❑ 3 g.p.h. (l.); ❑ 0.1 g.p.h. (2.); ❑ 0.2 g.p.h. (2.). Notes: 1. Required for equipment rt -up certification and annual certification. 2. Unless mandated by Walagency, certification required only for electronic LLD start-up. ❑ Yes ❑ No* Were all LLD's confirmed oegrditional and accurate within regulatory requirements? ❑ Yes ❑ No* Was the testing apparatusptoperly calibrated? ❑ Yes ❑ No* For mechanical LLD' oes the LLD restrict product flow if it detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic D's, does the turbine automatically shut off if the LLD detects a leak? ❑ N/A ❑ Yes ❑ No* For el ronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is disabled ❑ N/A or ' connected? ❑ Yes ❑ No* or electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system ❑ NJ malfunctions or fails a test? ❑ Yes ❑ * For electronic LLD's, have all accessible wiring connections been visually inspected? El /A E3 Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In Section H below, describe how and when these deficiencies were or will be corrected. H. Comments: TLM's & LLD's are monitored by Veeder Root.