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MONITWING SYSTEM CERTIWATION CERTIFICATION /TEST DATE: September 09, 2011 Al. FACILITY Yes ❑ A2. OWNER Has all input wiring been inspected for proper entry and termination, including testing for ground faults? Name 7 -Eleven Market #2368 / Store #32262 ❑ Name 7 -Eleven, Inc Address 2360 West Grantline Road, Tracy, CA 95376 ❑ Address P.O. Box 711, Dallas, TX 75221 Phone # 209-830-9917 ❑ Phone # 805-523-2949 Contact Stephen Boyd ❑ Contact Stephen Boyd F. IN -TANK GAUGING / SIR EQUIPMENT: ❑ 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 gaugung 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? * In Section H below, describe how and when these deficiencies were or will be corrected. G. LINE LEAK DETECTORS (LLD): Complete the following checklist: ❑ Check this box if LLDs are not installed. ■ Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? ❑ N/A (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 ❑ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ■ N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled ■ N/A or disconnected? ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions ■ N/A or fails a test? ❑ Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? ■ N/A ■ 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. H. COMMENTS Page 3 of 3