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Adak ANIL <br /> MON11170RING SYSTEM CER (CATION <br /> CERTIFICATION/TEST DATE: September 2, 2014 <br /> Al. FACILITY rAddress <br /> R <br /> Name 7-Eleven Market#2368/Store#32190 7-Eieven, Inc <br /> Address 4943 South State Route 99,Stockton,CA 95206 P.O.Box 711,Dallas,TX 75221 <br /> Phone# 209-939-0679 805-523-2949 <br /> Contact Stephen BoydStephen Boyd <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 properly? _ <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 verity LLD performance? <br /> ❑ NIA (check all that appty Simulated teak rate: 0 3 g.p.h.; ❑ 0.1 g.p.h.; ❑ 0.2 g.p.h. <br /> ❑ Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> ❑ Yes ❑ No* Was the testing apparatus properly calibrated? <br /> ❑ Yes ❑ No* For mechanical LLDs,does the LLD restrict product flow If It detects a leak? <br /> ❑ N/A <br /> ❑ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ❑ N/A <br /> ❑ 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 /> ❑ Yts ❑ No* For electronic LLDs,does the turbine automatically shut off If any portion of the monitoring system malfunctions <br /> ❑ NIA or fails a test? <br /> ❑ Yes ❑ No* For electronic LLDs,have all accessible wiring connections been visually Inspected? <br /> ❑ WA <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 /> H. COMMENTS <br /> 62014 Walton Englnewing,Inc. - <br /> Page 3 of 3 <br />