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Monitoring System Certification <br /> Site Address: 2448 W. KETTLEMAN LN <br /> Date of Testing/Service: 09/04/2002 <br /> F. In-Tank Gauging / SIR Equipment 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 /> IYes ❑No• Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br /> ❑Yes ❑No• Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ❑Yes F�]No• Was accuracy of system product level readings tested? <br /> Yes ❑No• Was accuracy of system water level readings tested? <br /> Yes ❑No• Were all probes reinstalled properly? <br /> 11 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) <br /> Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> ❑ <br /> X Yes For equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance? <br /> No' ❑N/A (Check all that apply)Simulated leak rate: E3 g.p.h ❑ 0.2 <br /> ❑ 9.P 0.1 g.p.h h <br /> X Yes ❑No' Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> X Yes ONo' Was the testing apparatus properly calibrated? <br /> ❑X Yes No ❑N/A For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> ❑Yes ❑No 0 N/A For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> DYes ❑No EIN/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 E N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> 1-1 Yes ❑NoN/A For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> LJ 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 /> H. Comments: <br /> page 3 of 3 <br />