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� p.,€ ., <br /> MONITORING SYSTEM CERTIFICATION 41 [[ , 1 <br /> CERTIFICATION/TEST DATE: August 8, 2017MIMI <br /> - <br /> A1. FACILITY A2. OWNER ,`.. : <br /> Name Quik Stop Market#39 Name Quik Stop Markets, Inc. <br /> Address 2285 E.Fremont Street,Stockton,CA 95205 Address 4567 Enterprise Street,Fremont,CA 94538 <br /> Phone# 510-657-8500 Phone# 510-657-8500 <br /> Contact Roger Batra I IContact Debbie Markovich <br /> F. IN-TANK GAUGING/SIR EQUIPMENT: E 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 gaugung equipment is used to perform leak detection monitoring. <br /> Complete the following checklist: <br /> ❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> ❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ❑ Yes ❑ No* Was accuracy of system product level readings tested? <br /> ❑ Yes ❑ No* Was accuracy of system water level readings tested? <br /> ❑ Yes ❑ No* Were all probes reinstalled properly? <br /> ❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> * In Section H below,describe how and when these deficiencies were or will be corrected. <br /> G. LINE LEAK DETECTORS (LLD): ❑ Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> ■ Yes ❑ No* For equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance? <br /> ❑ N/A (check all that apply) Simulated leak rate: E 3 g.p.h.; ❑ 0.1 g.p.h.; ❑ 0.2 g.p.h. <br /> ■ Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> Yes ❑ No* Was the testing apparatus properly calibrated? <br /> Yes ❑ No* For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> ❑ N/A <br /> ❑ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> N/A <br /> ❑ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> N/A or disconnected? <br /> ❑ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions <br /> N/A or fails a test? <br /> ❑ Yes ❑ No* For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> N/A <br /> Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> * In Section H below,describe how and when these deficiencies were or will be corrected. <br /> H. COMMENTS <br /> ©2016 Watton Engineering,Inc. <br /> Page 3 of 3 <br />