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Site Address: SS#6100 25775 S. Patterson Pass,Tracy Date of Testing/Servicing: 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 gauging equipment is used to perform leak detection monitoring. CoVaptete the following checklist: Y ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? es ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? Yes ❑ No* Was accuracy of system product level readings tested? es ❑ No* Was accuracy of system water level readings tested? es ❑ No* Were all probes reinstalled properly? Yes I ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the 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. Cqinplete the following checklist: Yes ElNo* For equipment start-up or annual equipment c1prtification, was a leak simulated to verify LLD performance? ❑ N/A (Check all that apply) Simulated leak rate: g.p.h.'; ❑ 0.1 g.p.h.'; El 0.2 g.p.h.' Notes: 1. Required for equipment start-up certification and annual certification. 2. Unless mandated by local agency,certification required only for electronic LLD start-up. s ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? Yes ❑ No* Was the testing apparatus properly calibrated? ❑ Yes ❑^ �o* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? E ,N/A Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑ N/A Yes F] No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled ❑ N/A or disconnected? Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions ❑ N/A or fails a test? EO�es ❑ No* For electronic LLDs,have all accessible wiring connections been visually inspected? ❑ N/A EV'Ves I ❑ No* I Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H,below, describe how and when these deficiencies were or will be corrected. H. Comments: Page 3 of 3 03/01