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10/19/2003 16:22 4089710135 SSS INC PAGE 04 <br /> Monitoring System Certification-Page 3 of 3 <br /> Site Address: 341 1-. Main St. Hwy-99 Date of"1"eesting/Setwicing- 8128103 <br /> F_ In -Tank Gauging/Silk Equipment: a Check this box if tank gauging is used only for inventory control. <br /> ❑ Check this box if no tank gauging or 61K equipment is installed. <br /> This section must be completed if in-tank: ganging equipment is used to perform leak detection monitoring. <br /> C:nm let e the following checklist: <br /> 13 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 /> Q Yes Cl No* Was accuracy of system product level readings tested'? <br /> Ll Yes ❑ NO Was accuracy of system,water level readings tested'? <br /> Q Yes ©No'' Were all probes reinstalled properly? <br /> ❑Yes ❑ 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 /> C. Linc Leak Detectors(LLD): n Check this box if LLD's are not installed. <br /> Complete the fol-lowing checklist: <br /> ❑ No* For equipment start-up or annual equipment certification was a leak simulated to verify LLL performance? <br /> 11 N/A (Cheek all that appl)) Simulated leak reate: 2 3 g•p.h.(1.); 13 0.1 g.p.h, (2.); 1701 g.p.h.(2.). <br /> Notes: 1. Required for equipment startup cert;firntion and annual certification.. <br /> 2. Unless mandated by local a en.ey,certification required Onlyfor electronic LLD start-up. <br /> rYei <br /> a Yes 11No* Were:all LLD's confirmed operational and accurate within regulator requirements? <br /> NYes ❑l�To* Was the testing apparatus PTOPCriy calibrated'? <br /> Q Yes ❑No* For mechanical LLD's,does the LLD restrict product flow if it detects a leak? <br /> Z N/A <br /> a Yes ❑No* For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak'? <br /> D NlA <br /> ®Yes ❑NO For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> ❑ N/A or disconnected? <br /> _FYes ❑No* For electronic LLD's,does the turbine automatically shut off if any pordoxi of tliu�,�uiutoriug system <br /> 13 N/A malfunctions or fails a test'? <br /> Ycs ❑No* For electronic LLD's,have all accessible wirin8 nonnections been visually inspected? <br /> ❑N/A <br /> ®Yes I I]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 /> H. Comments- <br />