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MONITORING SYSTEM CERTIFICATION JUN 07 2016 <br />CERTIFICATION /TEST DATE: June 2,2016 <br />I V <br />IM"I'M MEMO-. 0 mvs= r..N <br />nwom"Wo, <br />Al. FACILITY <br />A2. OWNER <br />Name Quik Stop Market #121 <br />Name Quik Stop Markets, Inc. <br />Address 1196 W. Louise Avenue, Manteca, CA 95336 <br />Address 4567 Enterprise Street, Fremont, CA 94538 <br />Phone# 510-657-8500 <br />Phone # 510-657-8500 <br />Contact Roger Batra <br />Contact Debbie Markovich <br />gug gp 'n"mm 77, 777 77770W,777 1177177 <br />F. IN -TANK GAUGING SIR EQUIPMENT: N Check this box if tank gauging is used only for inventory control. <br />1191 <br />El Check this box if no tank gauging or SIR equipment is installed. <br />Sm <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 0 No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />01 <br />El Yes <br />EJ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br />S <br />0 Yes <br />El No* Was accuracy of system product level readings tested? <br />El Yes <br />El No* Was accuracy of system water level readings tested? <br />A 0 Yes El No* Were all probes reinstalled properly? <br />Were all items on the equipment manufacturer's maintenance check <br />El Yeslist completed? <br />In Section H below, describe how and when these deficiencies were or will be corrected. <br />& 10� VIVI, Or"'IMM, 111110f <br />Ad G. LINE LEAK DETECTORS (LLD): 0 Check this box if LLDs are not installed. <br />BE <br />Complete the following checklist: <br />■ �2 <br />Yes <br />0 No* <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />El NIA <br />(check all that apply) Simulated leak rate: N 3 g.p.h.; El 0.1 g.p.h.; El 0.2 g.p.h. <br />Yes <br />0 Ncr* <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />Yes <br />D No* <br />Was the testing apparatus properly calibrated? <br />q 0 Yes <br />El No* <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />El N/A <br />N t <br />1 El Yes <br />El No* <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />ff <br />■ N/A <br />El Yes <br />0 No* <br />For LLDs, does the turbine if the is disabled <br />electronic automatically shut off any portion of monitoring system <br />1 <br />E N <br />?/A <br />or disconnected? <br />V <br />El Yes <br />El No* <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions <br />■ NIA <br />or fails a test? <br />El Yes <br />El No* <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />N N/A <br />0 Yes <br />El No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />l - OR H <br />In Section H below, describe how and when these deficiencies were or will be corrected. <br />LEMMME i" IIP.. <br />H COMMENTS <br />OR <br />0 2016 Walton Engineering, Inc. <br />Page 3 of 3 <br />