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0 Monitoring System Certification•Pagc 3 of 3 Site Address: 2905 W. Benjamin Holt Dr Date of Testingi"Servicing: 7128110 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 gauging equipment is used to perform leak detection monitoring. Complete the foil Ing checklist: ❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for gro 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 manufacturers maintenance chccklis ompleted? * In Section H below,describe how and when these deficiencies were or will be co ectad. G. Line Leak Detectors(LLD): ❑ Check this b if LLD's are not installed. Complete the foil o-Ing checklist: ❑ Yes ❑ No* For equipment start-up or annual equipment certifica' n was a leak simulated to verify LLD performance. ❑ N/A (Check all that apply) Simulated leak reate:❑ 3 h.(l.); ❑ 0.1 g.p.h.(2.); ❑ 0.2 g.p.h.(2.). Notes: 1. Required for equipment start-up ce fication and annual certification. 2. Unless mandated b local a enc ertification required onlyfor electronic LLD start-up. ❑ Yes ❑ No* Were all LLD's confirmed o rational and a urate within rc utatory re uirements? ❑ Yes ❑ No* Was the testingapparatus properly calibrat ? ❑ Yes ❑ No* For mechanical LLD's,does the LLD res act product flow if it detects a leak? ❑ NIA ❑ Yes ❑ No* For electronic LLD's,does the turbin automatically shut off if the LLD detects a leak? ❑ NIA ❑ Yes ❑ No* For electronic LLD's, does theto inc automatically shut off if any portion of the monitoring system is disabled ❑ VA or disconnected? ❑ Yes 0 No* For electronic LLD's,does the rbine automatically shut off if any portion of the monitoring system ❑ N/A malfunctions or fails a test? ❑ Yes ❑ No* For electronic LLD's,have 11 accessible wiring connections been visually inspected? ❑ N!A ❑ Yes 1 ❑ No* I 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. H. Comments: