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Monering System Certification • <br /> Site Address: 4943 S. KINGSLEY (FRONTAGE RD) Date of Testing/Service: 11/29/2001 <br /> HWY 99 0 ARCH AIRPORT RD <br /> In—Tank Gauging / 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 gauging equipment is used to perform leak detection monitoring. <br /> Complete the following checklists <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 /> Yee ❑No Were all probes reinstalled properly? <br /> ❑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 /> Line Leak Detectors (LLD) ❑ 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 verify LLD performance? <br /> E1Yes [:]No []N/A (Check all that apply)Simulated leak rate: Q 3 g.p.h ❑0.1 g.p.h ❑0.2 g.p.h <br /> x Yes ❑No Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> x Yes ❑No Was the testing apparatus properly calibrated? <br /> []Yes ❑No 0 N/A For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> Dyes ❑No * ❑N/A For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> Dyes ❑No * ❑N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> Yes ❑No * ❑N/A For electronic LLDs,does the turbine automafically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> L�jEl Yes ❑No * ❑N/A For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> ❑Yes ❑No * I 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 /> PREM UNL STP SUMP APPDX 2 INCHES OF WATER. <br /> page 3 of 3 <br />