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Monibing System Certification 4b <br /> Site Address: 4943S. KINGSLEY (FRONTAGE RD) Date of Testing/Service: 07/18/2003 <br /> HWY 99 @ ARCH AIRPORT RD <br /> F. In-Tank Gauging / SIR Equipment 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 /> This section must be completed If In-tank gauging equipment Is used to perform leak detection monitoring. <br /> Complete the following checklist: <br /> MYes ❑No Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> MYes ❑No Were all tank gauging probes visually inspected for damage and residue buildup? <br /> M Yes ❑No Was accuracy of system product level readings tested? <br /> QYes ❑No Was accuracy of system water level readings tested? <br /> M Yes ❑No Were all probes reinstalled properly? <br /> ElYes I ONO 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 /> i. Line Leak Detectors (LLD) . <br /> ❑ Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> For equipment start-up or annual equipment certification,was a leak simulated to verity LLD performance? <br /> ED Yes ❑No _]N/A (Check all that apply)Simulated leak rate: 0 3 g.p.h❑0.1 g.p.h ❑0.2 g.p.h <br /> MY.- ❑No Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> F_q Yes [:]No Was the testing apparatus properly calibrated? <br /> Ely-- ❑No [!]N/A For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> ❑Yes ❑No ❑N/A For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ID 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 /> E1Yes ON. ❑N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> ElYes ONO ❑N/A For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> El Yes ONO 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 <br />