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66/19/2003 16:35 408971Q'?5 SSS INC PAGE 04 Monitoring System Certification-Page 3 of 3 Site Address; 4315 Waterloo Rd. @ Hwy.99 Date of Testing/Servicing: 05121103 F. In-Tank Gauging I SIR Equipment: 14 Check this box if tank gauging is used only for inventory control, Ll 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 0 No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? ❑Yes ❑ No* Were all rank gauging probes visually inspected for darnage 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 al(probes reinstalled properly? ©Yes ❑ No* Were all items on the,equipment manufacturer's maintenance checklist completed'? *In Section H below,describe how and wltcn these deficiencies were or will be corrected. G. Line Leak Detectors(LLD): ❑ Check this box if LLD's are not installed- Complete nstalled_Com lete the following checklist: Oq Ycs Q Nu* Fur cKuipirreul sl.ar l-up vi aturual Cquipruatrt cCrtilicadun was a leak simulated to verify LLD performance? ❑ N/A (Check all that apply) Simulated leak reate: 0 3 g.p.h.(1.); © 0.1 g.p.h.(2); ❑ 02 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. 0 Yes 1 0 No* Were all LLD's confirmed operational and accurate within regulatory requirements? as Yes u No' was the testing apparatus properly calibrated? M Yes 0 No* For mechanical LLD's,does the LLD restrict product flow if it detects a leak? R N/.A 01 Yes ❑ No* For electronic LLD's,does the turbine automatically shut off if the LLD detects a leak? Q N/A _ ®Yes ❑ No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system is disabled Cl N/A or disconnected? ®Yes ❑ No* For cleCtiouic LLD's,dues the LuzLiztc 2LutulI14Li4411y blzul u.ff if 411y pu>tiuu of aiC rrrurrituring system ❑ N/A malfunctions or fails a test? ®Yes ❑ .No* For electronic LLD's,have all accessible wiring connections been visually inspected? ❑ N/A a Yes 0 No* Were all items on the equipment manufacturer's maintenance checklist completed? *In Section H below,describe bow and when these deficiencies were or will be corrected. II. Comments: