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FEB -14-2012 08:02 Service Station Systems 408 938 8888 P.05 <br />Monitoring System Certification -,Page 3 of 3 <br />Site Address: 35 N. Cherokee Ln. <br />Date of Testing/Servicing; 4/98/42 <br />F. In - Tank Gauging / SIR Equipment: 9 Check this box if tank gauging is used only for inventory control. <br />0 Check this box if no tank gauging or SIR equipment is installed. <br />This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. <br />❑ Yes <br />❑ No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />0 Yes <br />❑ No* <br />Were all tank gauging probes visually inspected for damage and residue buildup'? <br />❑ Yes <br />❑ No* <br />Was accuracy of system product level readings tested? <br />❑ Yes <br />❑ No* <br />Was accuracy of system water level readings tested? <br />0 YesCI <br />NO <br />Were all probes reinstalled properly? <br />0 Yes <br />Q No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In Section Il below, describe how and when these deficiencies were or will De corrected. <br />G. Line Leak Detectors (LLD).* 0 Check this box if LLD's are not installed. <br />19Yes❑!No*v <br />For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? <br />C3 N/A <br />(Check all that. apply) Simulated leak rate: X 3 g.p.h. (1.); 0 0.1 g.p.h. (2.); ❑ 0.2 g.p.h. (2). <br />Notes; 1. Required for equipment start-up certification and annual certification. <br />2. Unless mandated bX local a cnuy, certification required only for electronic LLD start-up. <br />M Yes <br />© No* <br />Were all LLD's confirmed operational and accurate within regulatory requirements? <br />3 Yes <br />❑ No* <br />Was the testing apparatus proRcrly calibrated? <br />R Yes <br />❑ No* <br />For mechanical LLD's, does the LUD restrict product flow if it detects a leak? <br />❑ N/A <br />❑ Yes <br />❑ No* <br />For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak'? <br />® N/A <br />0 Yes <br />❑ No's <br />For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />0 N/A <br />or disconnected? <br />❑ Yes <br />0 No's <br />For electronic U,Us, does the turbine automatically shut off if any portion of the monitoring system <br />a N/A <br />malfunctions or fails a test? <br />❑ Yes <br />q No* <br />For electronic LLD's, have all accessible wiring connections been visually inspected'? <br />0 N/A <br />® Yes <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: Purged 150 Gallons to get Diesel to pass, Diesel LLD passed after purge. <br />