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ft/19/20l'ti 139:25 831648 4 SPECIAL SERVICE PAGE 04 <br /> Monitoring System CertifiCation <br /> Address: 124 W, ELM ST.LODI 95242 Service Date:07/30/2008 <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 following checklist <br /> oyes ❑No` Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> QYes ❑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 /> []Yes ONo* Were all probes rainstallad properly? <br /> 0Yes ONO* Were all items on the equipment manufacturers maintenance checklist completed? <br /> 1n 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 /> []Yes O Noo For equipment start-up or annual equipment certification,was a leak simulated to verify LLD <br /> performance? <br /> ❑N/A Simulated Leak Rate(check all that apply) []3.0 g.p.h ❑0.1 g.p.h ❑0.2 g.p.h <br /> [ Yes ❑No` Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> []Yes [:]No* Was the testing apparatus properly calibrated? <br /> [jYes ❑No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br /> ❑N/A <br /> ❑Yes ❑No. For electronic LLDs,does the turbine automatically shut off if the LLD detects a teak? <br /> (❑N/A <br /> (QYes ❑No` For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is <br /> C7 N!A disabled or disconnected? <br /> ❑Yes ❑No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system <br /> malfunctions or fails a test? <br /> ❑NIA <br /> ❑Yes ®No" For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> d N/A <br /> DYes []No* Were all items on the equipment manufacturers maintenance checklist completed? <br /> *In the Section H below,des cnbe how and when these deficiencles were or will be corrected <br /> H. Comments <br /> ALL FUNCTIONS ARE NORMAL,THEREFORE NO GROUND FAULTS ARE PRESENT AT THIS TIME. <br /> Page 3 of 4 <br />