COMPLIANCE INFO_2011-2012 - Laserfiche WebLink

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MONIT$RING SYSTEM CERTIOCATION CERTIFICATION / TEST DATE: June 5, 2012 Al. FACILITY Yes ❑ A2. OWNER Has all input wiring been inspected for proper entry and termination, including testing for ground faults? Name CRLLC #2705446 ❑ Name Pacific Convenience and Fuels, LLC Address 1403 Country Club Blvd., Stockton, CA 95204 ❑ Address 7108 Koll Center Pkwy, Ste 100, Pleasanton, CA 94566 Phone # 209-943-2082 ❑ Phone # 925-884-0827 Contact Roger Fernandez ❑ Contact Tony Gross! 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 gaugung equipment is used to perform leak detection monitoring. Complete the following 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 checklist completed? * In 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.; ❑ 0.2 g.p.h. ❑ 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 malfunctions ❑ N/A or falls a test? ❑ Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? ❑ N/A ❑ 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. Page 3 of 3