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Monitoring System Certification - Page 3 of 3 10 e Site Address: 2701 March Ln. Date of Testing/Servicing: 12/20/12 F. In - Tank Gauging / SIR Equipment: CO Check 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. Com lets the foll ing checklist: ❑ Yes 1 ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ❑ Yes ❑ No* Were all tank gauging probes visually inspected for damage 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 all probes reinstalled properly? ❑ Yes I ❑ 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): ❑ Check this box if LLD's are not installed. COmnlete the fallnwina rharlrlie*- ® 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 rate: a 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 a enc , certification required only for electronic LLD start-up. 00 Yes ❑ No* Were all LLD's confirmed operational and accurate within regulatory requirements? 00 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? ❑ N/A ❑ Yes ❑ No* For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak? 00 N/A ❑ 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? ❑ Yes ❑ No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system M N/A malfunctions or fails a test? ❑ Yes ❑ No* For electronic LLD's, have all accessible wiring connections been visually inspected? 110 N/A N Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? •• in aecilon n aelow, describe how and when these deficiencies were or will be corrected. H. Comments: