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Feb 05 16 05;37a Kevin Hur 209-825-1532 p.7 <br />® Check this box H tank gauging is used only <br />F. tn.-rw* eauging f SIR Equipment: ❑ Checkft boX InO tank gauging or SIR is <br />This section must be comm if in -tank gauging equipment is used to perform leek detection monitoring. <br />Complete the following Checklist <br />Yes ❑ No. Has ail Input wiring tram iergperded for proper entry and tamllinadw, incwftg tesfing for ground faults? <br />Yes ❑ No' were ad tank gauging primes aisuariy d for damage and residue buildup? <br />Yes ❑ No* was accuracY Of System productreadir�s tseted? <br />Ar* <br />Yes ❑ No• Was aoxmacY df system water new l readings tested? <br />Yes ❑ No° were all probesnainsfalied Property? <br />Yes ❑ Nor Iware ag items on the �uipn+ernt rnufacturer s malntenanOe checkls4 ro<+rP? <br />M <br />❑ Check this box tl LLDS are not install0. <br />LIM Leak (LLD): <br />Con+ tete the farr6n to verify LLD �rfamance7 fCireclr off that appry} <br />Seek <br />® Yes <br />® �° <br />was <br />start-up <br />rata: For ecielpment ® g P h.; ❑ 0.1 9 Wh ; ❑nt �.h a <br />0 Yes <br />❑ WA <br />❑ NO <br />Simulatedleak <br />were all LLtb confirmed and accurate within nagulatory requirements? <br />0 Yes <br />❑ No' <br />was the treating apparatus prtaperly bated? <br />® Yes <br />❑ No• <br />For mechanical LLDs, does the LLD resale product flour if it detects a leak? <br />❑ ye <br />❑ N/A <br />❑ No' <br />For electronic LLDs, does the turbine aulomaticelly stud off if LLD dsmcls a leak? <br />® WA <br />LLDs, does the turbine automatically shut off if am/ pO rtkfn of the monitoring system disabled Or donnectad? <br />❑ Yes <br />❑ Na" <br />For demonic <br />0 NIAof <br />❑ NO* <br />Fof elecrml� LLDs. does the turbine automatically shut off if any portion Ihe mOnftoring systern malfunctions Or fags a test? <br />❑ Yes <br />❑ y� <br />® WA <br />❑ No• <br />For electronic LLDs, have all wiring connections been visually inspected? <br />Yes <br />0 WA <br />❑ Ne <br />all items on the equipmentmanufacturer's maintenance completed? <br />n m deficiencies were or will oe co - <br />. Comments: <br />87 120 3 25 21 PASS <br />91 140 3 28 22 PASS <br />DSL 130 4 27 22 PASS <br />2121107 <br />NIMI System Certlecatlan <br />Page 3 of a <br />