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AUG 15
<br />CERTIFICATION /TEST DATE: August 08, 2018 1
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<br />A1. FACILITY A2. OWNER ENVIRONNIENTA
<br />Name Quik Stop Market # 39 Name Quik Stop Markets, Inc. DE PA RTINI ENT
<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 Ro or Batra Contact Debbie Markovich
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<br />F. IN -TANK GAUGING / SIR EQUIPMENT: ■ 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 ❑
<br />No*
<br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults?
<br />❑
<br />Yes
<br />❑
<br />No*
<br />Were all tank gauging probes visually inspected for damage and residue buildup?
<br />❑
<br />Yes
<br />❑
<br />No*
<br />Was accuracy of system product level readings tested?
<br />❑
<br />Yes
<br />❑
<br />No*
<br />Was accuracy of system water level readings tested?
<br />❑
<br />Yes
<br />❑
<br />No *
<br />Were all probes reinstalled properly?
<br />❑
<br />Yes
<br />❑
<br />No *
<br />Were all items on the equipment manufacturer's maintenance checklist completed?
<br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak?
<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 />* In Section H below, describe how and when these deficiencies were or will be corrected.
<br />H. COMMENTS
<br />Adjusted the 91 MLLD before achieving passing results.
<br />Page 3 of 3
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<br />Yes
<br />❑
<br />No*
<br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance?
<br />❑
<br />N/A
<br />(check all that apply) Simulated leak rate: N 3 g.p.h.; ❑ 0.1 g.p.h.; ❑ 0.2 g.p.h.
<br />■
<br />Yes
<br />❑
<br />No*
<br />Were all LLDs confirmed operational and accurate within regulatory requirements?
<br />■
<br />Yes
<br />❑
<br />No*
<br />Was the testing apparatus properly calibrated?
<br />■
<br />Yes
<br />❑
<br />No*
<br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak?
<br />❑
<br />N/A
<br />❑
<br />Yes
<br />ElNo*
<br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak?
<br />■
<br />N/A
<br />ElYes
<br />ElNo*
<br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled
<br />■
<br />N/A
<br />or disconnected?
<br />❑
<br />Yes
<br />❑
<br />No*
<br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions
<br />■
<br />N/A
<br />or fails a test?
<br />❑
<br />Yes
<br />❑
<br />No*
<br />For electronic LLDs, have all accessible wiring connections been visually inspected?
<br />■
<br />N/A
<br />■
<br />Yes
<br />❑
<br />No*
<br />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 />Adjusted the 91 MLLD before achieving passing results.
<br />Page 3 of 3
<br />4M
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