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_nitoring System Certification <br /> Site Address: 1987 WEST 11 TH Date of Testing/Service: 09/16/2002 <br /> F. In-Tank Gauging / SIR Equipment M Check this box if tank gauging is used only for inventory control. <br /> E] 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 /> Yes ❑No Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> 11 Yes O No Were all tank gauging probes visually inspected for damage and residue buildup? <br /> Yes FINo` Was accuracy of system product level readings tested? <br /> Yes ❑No Was accuracy of system water level readings tested? <br /> Yes FjNo Were all probes reinstalled properly? <br /> Yes ❑No 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 /> G. Line Leak Detectors (LLD) : Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> Fx] For equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance? <br /> Yes ❑No' ❑NA <br /> (Check all that apply)Simulated leak rate: 0 3 g.p.h E]0.1 g.p.h 00.2 g.p.h <br /> FX—]Yes ❑No Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> X Yes [:]No Was the testing apparatus properly calibrated? <br /> F]Yes ❑No' Q N/A For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> Yes ❑No ❑N/A For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> Yes ❑No" ❑N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> 0 Yes ❑No` ❑N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> QYes ❑No ❑N/A For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> MYes ❑No 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 />