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Site Address: 124 W. ELM STREEI&ODI,CA. Uft of Testing/Servicing: 08-16-2007 _ NV IW F. In-Tank Gauging/SIR Equipment: ® Check this box if tank -au-in-� � 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. Com lete the following checklist: ❑ Yes ® No* Has all input wiring been inspected for proper entry and termination, including testing for around 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 I ® No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H,below,describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): ® Check this box if LLDs are not installed. Complete the following checklist: ❑ Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? ❑ N/A (Check all that apply) Simulated leak rate: ❑ 3 g.p.h.'; ❑0.1 g.p.h.2; ❑ 0.2 g.p.h.' Notes: 1. Required for equipment start-up certification and annual certification. 2. Unless mandated by local agency,certification required only for electronic LLD start-up. ❑ Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? ❑ Yes ❑ No* Was the testing apparatus properly calibrated? ❑ Yes ❑ No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled ❑ N/A or disconnected? ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system ❑ N/A malfunctions or fails a test? ❑ Yes ❑ No For electronic LLDs, have all accessible wiring connections been visually inspected? ❑ N/A ❑ Yes ❑ No* I Were all items on the equipment manufacturer's maintenance checklist completed? * 11 In the Section H,below,describe how and when these deficiencies were or will be corrected. H. Comments: NO OTHER SENSORS OR PROBES WERE INSPECTED OR TESTED AT THIS TIME. l t t