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itoring System Certification <br /> Site Address: 3202 W HAMMER LANE Date of Testing/Service: 03/20/2006 <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 gauging 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 M No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> Yes MNo* Was accuracy of system product level readings tested? <br /> ❑Yes MNo* Was accuracy of system water level readings tested? <br /> Yes QNo* Were all probes reinstalled properly? <br /> Yes I QNo* Were all items on the equipment manufacturers'maintenance checklist completed? <br /> *In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors (LLD) : D Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> For equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance? <br /> Yes ❑No*.QN/A (Check all that apply)Simulated leak rate: Q 3 g.p.hE]0.1 g.p.h ®02 g.p.h <br /> Yes ❑No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> Yes ®No* Was the testing apparatus properly calibrated? <br /> Yes ❑No* NIA For mechanical LLDs,does the LLD restrict product flow if it detects a leak? <br /> Yes ❑No* M N/A For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ❑Yes QNo* _Q N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> Yes ❑No* M N/A For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> M Yes �MNo* 0 NIA For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> U <br /> Yes No* Were all items on the equipment manufacturers'maintenance checklist completed? <br /> *In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> DID NOT TEST LD'S. DSL&91 ANNULAR SENSORS STUCK IN PLACE. 91 SENSOR BROKE WHILE TRYING TO ROCK IT FREE <br /> CONTACTED SOLVEONE TO REAPIR. EXTERNAL ALARM INOPERABLE AND COULD NOT REPAIR CONTACTRED SOLVONE <br /> FOR REPAIRS. <br /> Page 3 of 3 Based on CA form dated 03/01 <br />