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POB 36 26515 N. SACTO. 13L. <br /> ntinuous Monitoring <br /> THORNTON, CA 956$6 <br /> .209 794-0102 800 524-9067 Device Certification <br /> TEST DATE t d 7 -- z K- <br /> SITE: <br /> OPBRATOR L,D-74- 5'bpJ5 Station# OWNER <br /> SITS ADDRESS a L. �`� r� -f' 1'- ADDRESS <br /> PRONE ( ) - PHONE ( j <br /> MAKE AND MODEL OF MONITORING SYSTEM 3 <br /> I <br /> Contents of Tank K� a� <br /> Capacity of Tank <br /> Type of Product Line: (Gravity, Suction, Pressure). <br /> ce� <br /> INDICATE LOCATION OF THE MONITORING SENSORS TESTED BY PLACING A YES OfN PI!UC OX: <br /> Annular Space Sensor ��I Y�w `If5 vis YE.t) <br /> t k I <br /> Sump Sensor , e .-�cc <br /> Electronic Overfill I Level <br /> Electronic In-Line Leak Detector VC) 0 WD A) 1� <br /> Mechanical Line Leak Detector 1 pz4nD Lf A-,pv,opD k07ccQ A�D <br /> In Tank Gauging Device <br /> INDICATE THE FOLLOWING BY PLACING A YES OR NO IN APPLICABLE 80X: <br /> Does the monitoring system have audible and visual alarms? <br /> Does the turbine automatically shut-down if the system detects 0 A)D A U �O 0 <br /> a leak, falls to operate or is electronically disconnected? <br /> Is the monitoring system installed to prevent unauthorized tampering? y:r 7'.-C" c, '` Yep <br /> Is the monitoring system operable as per the manufacturer's specifications? "" <br /> Which continuous monitoring devices Inlilate'positive shut-down of the turbine? <br /> CERTIFIED TESTERS ID# ( <br /> SIGNATURE OF CERTIFIED TECHNICIAN ; r ire_ *c- ,i••{� <br /> PRINTED NAME OF CERTIFIED TECHNICWN -mac 111 (7 <br />