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MONITORING SYSTEM CERTIFICATION <br /> CERTIFICATION /TEST DATE: January5, 2016 <br /> Al. FACILITY A2. OWNER <br /> Name Colonial Energy#40135 Name Colonial Energy,LLC. <br /> Address 192 Lathrop Road,Lathrop,CA 95330 Address 2860 N.Santiago Blvd.2nd Floor,Orange,CA 92667 <br /> Phone# 209-858-4998 Phone# 714-761-5426 <br /> Contact Station Manager Contact Victor Hassan <br /> F. IN-TANK GAUGING I SIR EQUIPMENT: ■ 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 /> This section must be completed if in-tank gaugung equipment is used to perform leak detection monitoring. <br /> Complete the following checklist: <br /> ❑ 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 /> ❑ Yes ❑ No' Was accuracy of system product level readings tested? <br /> ❑ Yes ❑ No• Was accuracy of system water level readings tested? <br /> ❑ Yes ❑ No" Were all probes reinstalled property? <br /> ❑ Yes ❑ No' 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 /> G. LINE LEAK DETECTORS (LLD): ❑ Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> ■ Yes ❑ No' For equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance? <br /> ❑ N/A (check all thatapply) Simulated leak rete: ■ 3g.p.h.; ❑ 0.1 g.p.h.; ❑ 0.2 g.p.h. <br /> ■ Yes ❑ No a Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> ■_ Yes ❑ No* Was the testing apparatus properly callbrated? _ <br /> ❑ Yes ❑ No• For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> ■ NIA <br /> ■ Yes ❑ No• For electronic LLDs,does the turbine automatically shutoff if the LLD detects a leak? <br /> ❑ N/A <br /> j ■ Yes ❑ No For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> ❑ NIA or disconnected? <br /> ■ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions <br /> LLYM ❑ NIA or falls a test? <br /> e ❑ No' For electronic LLDs,have all accessible wiring connections been visually Inspected? <br /> ❑ NIA <br /> es ❑ No' 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 <br /> JAN 2 z [uii <br /> ENVIRIONMENTAt HEALTH <br /> DEPARTMENT <br /> 02015 Walton Engineering,Inc. <br /> Page 3 of 3 <br />