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AUG-21-2004 17:21 SERVICE STATION SYSTEM 4oe 971 0135 P.04 Monitoring System Certification-Pab_3 of 3 Site Address: 6131 Pacific Ave. @ Porter Date of Testing/Servicing: 7/26/04 F. In-Tank Gauging/SIR Equipment_ K Check this box if tank gauging is used only for inventory contro' ❑ 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? a Yes ❑ No* Was accuracy of system water level readings tested? ❑Yes ❑ No* Were all probes reinstalled properly? p 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): p Check this box if LLD's are not installed. Complete the following checklist: 11 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: Qg 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. pg Yes ❑ No* Were all LLD's confirmed operational and accurate within regulatory requirements? ej Yes ❑No* Was the testing apparatus properly calibrated? ❑Yes ❑ No* For mechanical LLD's,does the LLD restrict product flow if it detects a leak? � Qg N/A ja Yes ❑No* For electronic LLD's,does the turbine automatically shut off if the LLD detects a leak? ❑N/A pg 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? N Yes 0 No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system ❑N/A malfunctions or fails a test? K Yes a No* For electronic LLD's,have all accessible wiring connections been visually inspected? ❑N/A Ig Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? *In Section H below,describe ho rw and when these deficiencies were or will be corrected. H. Comments: