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Monitoring System Certification Page 3 of 3 Site Address: 1409 S. Airport Way Date of Testing/Servicing: 615114 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 gauging equipment is used to perform leak detection monitoring. Com ylete 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? ❑ Ycs ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In Section 11 below,describe how and when these deficiencies were or will be.corrected. G. Line Leak.Detectors(LLD): ❑ Check this box if LLD's are not installed. Complete the foliowin checklist: 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.(1.); R 0.1 g.p.h.(2.); ❑ 0.2 g.p.h.(2.). Notes: 1. Required for equipment start-up certification itnd annual certification. 2. Unless mandated by local a enc ,certification required only for electronic LLD start-up. ® Yes ❑ No* Were all LLD's confirmed operational and accurate within regulatory requirements? Do Yes ❑ No* Was the testing apparatus ero2erly calibrated? 0 Yes ❑ No* For mechanical LLD's,does the LLD restrict product flow if it detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LLD's,does the turbine automatically shut off if the LLD detects a leak? M N/A ❑ Yes ❑ No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system is disabled 19 N/A or disconnected? ❑ Yes ❑ No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system Z N/A malfunctions or fails a test? 0 Yes ❑ No* For electronic LLD's,have all accessible wiring connections been visually inspected? N/A M 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: —, y JUN 3 0 2014 ENVIRONMENT;qr-