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Monitoring System Certification is <br />Site Address: 1960 W. 11TH STREET <br />F. In -Tank Gauging / SIR Equipment <br />Date of Testing/Service: 06/04/2002 <br />® 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 />Yes <br />E]No * <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />E] Yes <br />Fj No * <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />E] Yes <br />F ]No* <br />Was accuracy of system product level readings tested? <br />Yes <br />F-] No * <br />Was accuracy of system water level readings tested? <br />Yes <br />F] No * <br />Were all probes reinstalled properly? <br />Yes <br />1:1 No * <br />Were all items on the equipment manufacturers' maintenance checklist completed? <br />III IIIC OCtAlUll ", uClVW, UVb%AIUe IIVW iIIIU WIICII UItlJe UUMAUncle5 Were Ur WIII De cUrfSeiea. <br />G. Line Leak Detectors (LLD) : ❑ Check this box if LLDs are not installed. <br />Complete the following checklist: <br />® Yes <br />No • <br />N/A <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />(Check all that apply) Simulated leak rate: ® 3 g.p.h ❑ 0.1 g.p.h 00.2 g.p.h <br />® Yes <br />❑ No * <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />® Yes <br />No * <br />Was the testing apparatus properly calibrated? <br />El Yes <br />No ` <br />© N/A <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />® Yes <br />E]No * <br />F-1 N/A <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />® Yes <br />E]No* <br />F-] N/A <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br />® Yes <br />F�No * <br />❑ N/A <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br />® Yes <br />E]No * <br />F-] N/A <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />MYes <br />E]No* <br />Were all items on the equipment manufacturers' maintenance checklist completed? <br />Irl uIe oecuon n, oelow, aescnoe now ano wnen inese aenciencies were or wm oe correciea. <br />H. Comments: <br />Michael Levesque <br />VR Cert 000-00-5505 <br />Tanknology <br />Lic # 743160 <br />page <br />