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MONITdONG SYSTEM CERTIFJOATION <br />CERTIFICATION / TEST DATE: March 5, 2012 <br />A1. FACILITY A2. OWNER <br />Name 7 -Eleven Market #2368 / Store #19976 Name 7 -Eleven, Inc <br />Address 1399 N. Main Street, Manteca, CA 95336 Address P.O. Box 711, Dallas, TX 75221 <br />Phone# 209-239-3252 Phone# 805-523-2949 <br />Contact Stephen Boyd Contact Stephen Boyd <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 gaugung 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 />❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br />❑ Yes ❑ 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 />❑ Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br />* In 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 />* In Section H below, describe how and when these deficiencies were or will be corrected. <br />H. COMMENTS <br />na. Inc <br />Page 3 of 3 <br />rformance? <br />tem is disabled <br />tem malfunctions <br />