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MAR-12-2012 14: 12 Service Station Systems 408 938 8888 P.aS Monitoring System Certification - rage 3 of 3 Site Address: 340$ Manthey Road - ^ Date of Testing/Servicing: 2/13/12 F. in -Tank Gauging/SIR Equipment: 1P 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. Com lett the folio ing checklist: ❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? 0 Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? 0 Yes 0 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 0 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 I.,eak Detectors (LLD): D Check this box if LLD's are not installed. Cam lete the folio M2 checklist: 0 Yes 0 No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance., ❑ N/A (Che(:k all that apply) Simulated leak rate: IM 3 s.p,h. (1.); ❑ 0.1 g.p.h. (2.); ❑ 0.2 g.p.h.(2.), Notes: 1. Required for equipment start-up certification anti annual Certification. 2. Unless mandated by local agency,certification required only for electronic LLD start-up. 0 Yes ❑ No* Were all LLO's confirmed o crational and accurate within regulatory requirements? 3 Yes ❑ No* Was the testing apparatus properly calibrated? ❑ Yes ❑ No* For mechanical LLD's,docs the LLE?restrict product flow if it detects a leak? 0 N/A ® Yes ❑ No* For electronic LLD's,does the turbine autornaticztlly shut off if the LLD detects a leak? ❑ N/A 3 Yes ❑ No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system is disabled 0 N/A or disconnected? Ycs ❑ No* For electronic LLD's,docs the turbine automatically shut off if any portion of the monitoring system ❑ N/A malfunctions or fails a test? W Yes ❑ No* For electronic LT.,D's, have all accessible wiring connections been visually inspected? 0 N/A 19 Yes Q No* Were all items on the equipment manufacturer's maintenance checklist completed'? * In Section Flt below,describe how and when these deficiencies were or will he Corrected. H. Comments: