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Monitoring System Certifiestt,_ -Page 3 of 3 Site Address: 6131 Pacific Ave. @ Porter Date of Testing/Servicing: 10/7104 r... F. In-Tank Gauging 1 SIR Equipment: � Q9 heck 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: Lo Yes 1 ❑ NoHas alt input wiring been inspected for proper entry and termination, including testing for ground faults? p Yes ❑ No• Were all tank gauging probes visually inspected for damage and residEbuild ❑Yes ❑ No' Was accuracy of system product level readings tested? ❑Yes Q No* Was accuracy of system water level readings tested? I� ❑Yes ❑ No' Were all probes reinsFalled properly? ❑Yes ❑ No Were a!I ;terns on the equipment manufacturer's maintenance checklis *in Section H below,describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): p Check this box if LLD's are not installed. Complete the following checklist: a Yes ❑ No" I Forequipment start-up or annual equipment certification was a leak simulated to verify LLD performance? ❑N/A (Check all Mat applyj Simulated leak reate: el 3 g.p.h. (1.); p 0.1 g.p.h. (2.); p 0.2 g.p.h. (2.). j' Notes: 1. Required for equipment start-up certificationaU annual certification. 2. finless mandated by local agency,certification regt:ired only for electronic LLD start-up. ' Yes 1-0 No Were all LLD's on operational and accurate within regulatory requirements? Yes Q No* Was the testing apparatus properly calibrated? �r Yes Q No* For mechanical.LLD's, does the LLD restrict product flow if it detects a leak? 19 N/A a Yes Q No* For electronic LLD's,does the turbine automatically shut off if the LLD detects a leak? C3 N/A 9§Yes ❑ No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system is disabled ❑N/A or disconnected? J1 Yes a No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system 1 (3 N/A malfunctions or fails a test? II Qq Yes [2 N/A q No* For electronic LLD's,have all accessible wiring connections been visually inspected? ;A Yes Q 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. Comments: