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09/18/2002 09:46 120936'543 TANKNOLOGY PAGE 11/11 <br /> Monitoring system certification <br /> Site Address; 19,97 WEST 11TH Date of Testing/Service: 09/16/2002 <br /> in-Tank Gauging / SIR Equipment x❑ 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 checklist: <br /> Q Yes DNo Has all input wiring bean Inspected for proper entry and termination,Including testing for ground faults? <br /> a Yea 7No Were all tank gauging probes visually Inspected for damage and residue buildup? <br /> Yes ONo Was accuracy of system product level readings tested? <br /> EIYQA EINo Was accuracy of system water level readings tested? <br /> 71 yQ; No Were all probes reinstalled properly? <br /> YQC EINo 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 /> 0 Y`' ❑ �o ❑`r A (Check all that apply)Simulated leak rate; Q 3 g.p.h Q 0.1 g.p.h E]0,2 g.p.h <br /> x Yet O mo Ware all LLDs confirmed operational and accurate within regulatory requirements? <br /> 1-.L— <br /> M Yee FINo Was the testing apparatus properly calibrated? <br /> Ycc No [j]to,A For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> ElYPF ONo • ❑ri/A For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> Ya. []No Nrn For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> 0 YeF []too F714/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> x❑Yes F71qo F7NiA For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> Q Yea ONO 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 /> Michael Levesque <br /> VR Cert#000.00-5505 <br /> Tanknology Contractor Lic #743160 <br /> page 3 of 3 <br />