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Monitoring System Certification -40e 3 of 3 <br />Ll <br />Site Address:— 6633 Pacific Ave Date of Testing/Servicing: 2/1/13 <br />F. In - Tank Gauging / SIR Equipment: 19 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 />CninnIpte. the fh1inwinar Phneklivt- <br />0 Yes <br />0 No* <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults" <br />0 Yes <br />0 No* <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />D Yes <br />0 Yes <br />0 No* <br />0 No* <br />Was accuracy of system product level readings tested? <br />Was accuracy of system water level readings tested? <br />0 Yes <br />0 No* I <br />Were all probes reinstalled properly? <br />0 Yes <br />13 No* <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In Sectionfl. below, describe how and when these deficiencies were or will be corrected. <br />G. Line Leak Detectors (LLD)-. 0 Check this box if LLD's are not installed. <br />Comnlete the following checklist: <br />N Yes <br />0 No* <br />For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? <br />0 N/A <br />(Check all that apply) Simulated leak rate: 0 3 g,p.h. (1); 0 O. I g.p.h. (2); El 0.2 g.p,h, (1). <br />Notes: 1, Required for equipment start-up certification and annual certification. <br />2. Unless mandated by local agency, certification required only for electronic LLD start-up. <br />50 Yes <br />0 No* <br />Were all LLD's confirmed operational and accurate within regulatory requirements? <br />R Yes <br />Cl No* <br />Was the testing apparatus properly calibrated? <br />G Yes <br />0 No* <br />For mechanical LLD's, does the LLD restrict product flow if it detects a leak? <br />N N/A <br />0 Yes <br />0 No* <br />For electronic LLD's., does the turbine automatically shut off if the LLD detects a leak? <br />o N/A <br />09 Yes <br />0 No* <br />For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is disabled <br />Cl N/A <br />or disconnected? <br />ffi Yes <br />El No* <br />For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system <br />0 N/A <br />malfunctions or fails a test? <br />Yes <br />0 No* <br />For electronic LLD's, have all accessible wiring connections been visually inspected? <br />0 N/A <br />N Yes , <br />0 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: Replaced syphon jet, o -rings & purged lines. Re -tested several times with passing results. <br />