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IWIITTIM:455121 �' • + � f G. LINE LEAK DETECTORS (LLD): ❑ Check this box if LLDs are not installed. Complete the following checklist: CERTIFICATION / TEST DATE: Au ust 8, 2016 Al. FACILITY A2. OWNER ;117. ❑ Name Quik Stop Market # 39 Name Quik Stop Markets, Inc. Address 2285 E. Fremont Street, Stockton, CA 95205 Address 4567 Enterprise Street, Fremont, CA 94538 Phone # 510-657-8500 g Phone # 510-657-8500 (check all that apply) Simulated leak rate: 3 h.; ❑ 0.1 h.; ❑ 0.2 h. PP Y) 9•P• 9•P• 9•P• Contact Roger Batra Contact Debbie Markovich :=.. 477✓-'-,'. .t„2...n.: 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. Were all LLDs confirmed operational and accurate within regulatory requirements? This section must be completed if in -tank gaugung equipment is used to perform leak detection monitoring. Yes ❑ No* Complete the following checklist: 1n �.- ■ ❑ 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? ❑ N/A ❑ Yes ❑ No* Was accuracy of system water level readings tested? ' ❑ ❑ Yes ❑ No *Were all probes reinstalled properly? No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? I°t ❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? �M" Er.» �,, . :,. , .., .: i ❑ * In Section H below, describe how and when these deficiencies were or will be corrected. r, No* G. LINE LEAK DETECTORS (LLD): ❑ Check this box if LLDs are not installed. Complete the following checklist: "M °TMi:,#�'v'*ym''... "e.t:f: �i,,. FV- .T'. ab1�S.,:r „�.�:x.;.'3 .u..s$5��. 5... ® 2016 Walton Engineering, Inc. Page 3 of 3 ■ Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? _' ❑ NIA (check all that apply) Simulated leak rate: 3 h.; ❑ 0.1 h.; ❑ 0.2 h. PP Y) 9•P• 9•P• 9•P• ■ 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? I°t ■ NIA ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled f ■ NIA or disconnected? ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions x re ■ N/A or fails 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? E L: T, 2m�- * In Section H below, describe how and when these deficiencies were or will be corrected. -77 7 H. COMMENTS ch t y, �4 i "M °TMi:,#�'v'*ym''... "e.t:f: �i,,. FV- .T'. ab1�S.,:r „�.�:x.;.'3 .u..s$5��. 5... ® 2016 Walton Engineering, Inc. Page 3 of 3