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JAN-20-2012 11:09 Service Station Systems 408 938 8888 P.05 Monitoring System Certification-Page 3 of 3 Site Address: 3725 N.Tracy Blvd. Date of Testing/Servicing; 1/5/72 F, In-tank Gauging/SIR Equipment: 3 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. Com Tete the foliowin checklist: ❑ 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): ❑ Check this box if LLD's are not installed. Conn tete the follo- ing checklist: M Yes ❑ No* For equipment start-up or annual equipment certification was a leak simulated to verify L1.13performance? ❑ N/A (Check all that apply) Simulated leak rate: is 3 g.p.h.(t.); ❑ 0.1 g.p.h.(2.); ❑ 0.2 g.p.h.(2.). Notes: I. Required for equipment start-up certification ,£lam.annual certification. 2. Unless mandated by local a enc ,certification required only for electronic LLD start-up. a Yes ❑ No* Were all LLD's confirmed operational and accurate within re ulatory requirements? 3 Yes p No* Was the testing!22aratus Bro]gcrlX calibrated'? Cl Yes ❑ No* For mechanical LLD's,docs the LLD restrict product flow if it detects a leak? C1 N/A Do Yes a No* For electronic 1...1.0's,does the turbine automatically shut off if the LLD detects a leak? ❑ N/A C1 Yes 0 No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system is disabled ❑ N/A or disconnected? C1 Yes 0 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? 0 Yes ❑ No* For electronic LLD's,have all accessible wiring connections been visually inspected? D N/A ® Yes 1 ❑ Na* I Were all items on the equipment manufacturer's maintenance checklist completed? *In Section H below,describe how and when these deticiencles were or will be corrected. H. Comments: