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7AWonitoring System Certification <br /> W 141 <br /> Site Address: 2375 WEST GRANT LINE ROAD Date of Testing/Service: 05/28/2010 <br /> N-1094-1-5 <br /> F. In-Tank Gauging / SIR Equipment <br /> ❑x Check this box if tank gauging is used only for inventory control. <br /> ❑ Check this box if no tank gauging or SIR equipment is installed. <br /> 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 /> Complete the following checklist: <br /> 0 Yes ❑No" Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> ❑Yes ❑No" Were all tank gauging probes visually inspected for damage and residue buildup? <br /> E Yes ❑No" Was accuracy of system product level readings tested? <br /> ❑x Yes ❑No" Was accuracy of system water level readings tested? <br /> El Yes ❑No• Were all probes reinstalled properly? <br /> a Yes ❑No" Were all items on the equipment manufacturers'maintenance checklist completed? <br /> "In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors (LLD) : ❑ Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> M Yes ❑NoFor equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance? <br /> ' ❑N/A (Check all that apply)Simulated leak rate: x 3 h 0.1 h 0.2 h <br /> ❑ g•p• ❑ g•p• ❑ g•p• <br /> x Yes ❑No" Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> FX-1 Yes ❑No" Was the testing apparatus properly calibrated? <br /> ❑Yes ❑No" ®N/A For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> Q Yes ❑No° ❑N/A For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> M Yes ❑No" ❑N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> 0 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? <br /> ❑x Yes ❑No` ❑N/A For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> L'J Yes ❑No` Were all items on the equipment manufacturers'maintenance checklist completed? <br /> `In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> Page 3 of 3 Based on CA form dated 03/08 <br />