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Monitoring System Certification - Page 3 of 3 Site Address: 35 N. Cherokee Ln. Date of Testing/Servicing: 3/7/13 F. In - Tank Gauging / SIR Equipment: 11 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. rmmnlvtn tier fniinwina rhrrkliet- ❑ 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? ❑ 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 manufacturer's maintenance checklist completed? * In Section H below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors(LLD)- !"mmnlrtr thr fnilnwina rhrrtrUct- ® Check this box if LLD's are not installed, ❑ Yes ❑ No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? ❑ N/A (Check all that apply) Simulated leak rate: ❑ 3 g.p.h. (1.); ❑ 0.1 g.p.h. (2.); ❑ 0.2 g.p.h. (2). Notes: 1. Required for equipment start-up certification and annual certification. 2. Unless mandated by local agency, certification required only for electronic LLD start -u2, ❑ Yes ❑ No* Were all LLD's confirmed operational and accurate within re ulatory requirements? ❑ Yes ❑ No* Was the testing apparatus properly calibrated? ❑ Yes ❑ No* For mechanical LLD's, does the LLD restrict product flow if it detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is disabled ❑ N/A or disconnected? ❑ Yes ❑ No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system ❑ N/A malfunctions or fails a test? ❑ Yes ❑ No* For electronic LLD's, have all accessible wiring connections been visually inspected? ❑ N/A ❑ Yes ❑ No* I Were all items on the equipment manufacturer's maintenance checklist completed? Iii Section H below, describe how and when these deficiencies were or will be corrected. H. Comments: Not required to be tested.