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From: Franzen -Hill Inc. To: 12094683433 Page: 5/7 Date: 7!7/2011 11:14:45 AM Monitoring System Certification F. In -Tank Gauging / SIR Equipment: 0 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. Complete the following 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? to rue aecuon tit, nelow, descrnte h®w and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): Comnlete the fallowinar cheeklict: ❑ Check this box if LLDs are not installed. R Yes ❑ No* ❑ N/A For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) Simulated leak rate: ® 3 g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p h. ® Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? ® Yes ❑ No* Was the testing apparatus properly calibrated? ® Yes ❑ Na* ❑ N/A For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ Yes 19 No* 0 N/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑ Yes ® No* ® N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? ❑ Yes ® No* ® N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? ❑ Yes 0 No* RSI N/A For electronic LLDs, have all accessible wiring connections been visually inspected? 0 Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H. below. degerihe haw and when thee@ tipfii eipnric+c wprp nr will to nnemptari H. Comments: Page 3 of 3 This fax was sent with GFI FAXmaker fax server. For more information, visit: http:/Awm.gfi.com