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MONIT(- ZING SYSTEM CERTIF_DATION CERTIFICATION /TEST DATE: July 26, 2012 A7. FACILITY A2. OWNER Name 7-Eleven Market#2368/Store#17334 Name 7-Eleven, Inc Address 4501 North Pershing Street,Stockton,CA 95207 Address P.O.Box 711,Dallas,TX 75221 Phone# 209-951-6745 Phone# 805-523-2949 Contact Stephen Boyd Contact Stephen Boyd F. IN-TANK GAUGING/ SIR EQUIPMENT: ❑ Check this box if tank gauging is used only for inventory control. ❑ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gaugung equipment is used to perform leak detection monitoring. Complete the following checklist: ❑ Yes ❑ No• Has all Input wiring been Inspected for proper entry and termination,Including testing for ground faults? ❑ Yea ❑ No` Were all tank gauging probes visually inspected for damage and residue buildup? ❑ Yes ❑ No" Was accuracy of system product level readings tested? ❑ Yp ❑ No* Was accuracy of system water level readings toted? _ ❑ Yes ❑ No' Were all probes reinstalled property? ❑ Yes ❑ No• Were all items on the equipment manufacturer's maintenance checklist completed? In Section H below, describe how and when these deficiencies were or will be corrected. G. LINE LEAK DETECTORS (LLD): ❑ Check this box if LLDs are not installed. Complete the following checklist: ❑ Yes ❑ No For equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance? ❑ WA (check all that apply) Simulated leak rate: ■ 3 g.p.h.; ❑ 0.1 g.p.h.; ❑ 0.2 g.p.h. ❑ Yes ❑ No` Were all LLD&confirmed operational and accurate within regulatory requirements? _ ❑ Yea ❑ ll Was the testing apparatus properly calibrated? ❑ YM ❑ No a For mechanical LLDs,does the LLD restrict product flow H It detects a leak? ❑ WA ❑ Yes ❑ No a For electronic LLDs,does the turbine automatically shut oft H the LLD dialects a leak? ❑ WA ❑ Yes ❑ No" For electronic LLD*,does the turbine automatically shut off If any portion of the monitoring system Is disabled - ❑ WA or disconnected? ❑ Yes ❑ No" For electronic LLD%,does the turbine automatically shut off If any portion of the monitoring system malfunctions ❑ WA or falls a test? ❑ Yes ❑ No" For electronic LLD&,have all accessible wiring connections been visually Inspected? ❑ WA ❑ Yes ❑ No Were all Items on the equipment manufacturer's maintenance checklist completed? ' In Section H below,describe how and when these deficiencies were or will be corrected. H. COMMENTS ©2012 Walton Englneenng,Inc. Page 3 of 3