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AUG-28-2007 13:29 Service Station Systems 408 938 8888 P.05 Monitnring System Certification-Pa of 3 Site Address: 2448 W. Kettleman Ln. @ Lower Sacramento Date ofTcsting/Servicing: �J 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. Complete the following checklist: ❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination, inCluding testing for ground faults? ❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? ❑ Yes ❑ No* Was accuracy of system product level readings tested? ❑ Yes ❑ No* Was accuracy of system water level readings tested? ❑ Yes ❑ No* Were all probes reinstalled properly? ❑ 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 LLD's are not installed. Com I e the folio ing checklist: es ❑ No* For equipment start-up or annual equipment certif�ation was a leak simulated to verify LLD performance? ❑ N/A (Check all that apply) Simuiated leak reate:W1`3 g.p.h. (1.); ❑ 0.1 g.p.h. (2.); O 0.2 b.p.h. (2). 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. es ❑ Nos Were all LLD's confirmed operational and accurate within regulatory requirements? es ❑ No* Was the testing apparatus properly calibrated? es ❑ No* For mechanical LLD's,does the LLD restrict product flow if it detects a leak? ❑ N/A ❑ Yes ❑ No* . For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak'? A ❑ Yes ❑ Nom; For electronic LLD's. does the turbine automatically shut off if any portion of the monitoring system is disabled t�'hl/A or disconnected? ❑ Yes ❑ No* For electronic L.LD's, does the turbine automatically shut off if any portion of the monitoring system /A malfunctions or fails a test? ❑ Yes ❑ No*. For electronic LLD's, have all accessible wiring connections been visually inspected? L� tYl�/A es ❑ 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. Cotnments; l Fz1�, k) — �"cj C� rS I f7dlrf�G' TOTAL P.05