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JUN-26-2009 08:26 Service Station Systems 408 938 8888 P.05 Monitoring System Certification -Pati 13 Site Address: 2448 W. Kettleman Ln. a Lower Sacramento Date of Testing/Servicing: 5127109 F. In-Tank Gauging/SIR Equipment: 1d 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 p No* Were all tank gauging probes visually inspected for damage and residue buildup? ❑ Yes ❑ No' Was accuracy of system product level readings tested? ❑ Yes ❑ Nos 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): l3 Check this box if LLD's are not installed. Complete the rollo ing checklist: IS Yes ❑ No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? ❑ N/A (Check all that apply) Simulated leak reate:to 3 g.p.h.(1.); ❑ 0.1 g.p.h. (2.); ❑ 0.2 g.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. CK Yes ❑ No* Were all LLD's confirmed operational and accurate within regulatory requirements? M Yes ❑ No* Was the testing apparatus properly calibrated? QI Yes 17 No* For mechanical LLD's,does the LLD restrict product flow if it detects a leak? ❑ N/A C3 Yes 0 No* For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak? la N/A Cl Yes ❑ No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is disabled f8 N/A or disconnected? ❑ Yes ❑ No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system 18 N/A malfunctions or fails a test? ❑ Yes ❑ Not For electronic LLD's,have all accessible wiring connections been visually inspected? M N/A 1a Yes ❑ No* I 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. Comments: