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APR -26-2012 09:19 S rice Station Systems 408 938 8888 P.05 Monitoring System Certification - Page 3 of 3 Site Address: 2704 March Ln. Date of Testing/Servicing: 3129/42_ F. In - Tank Gaming / SYR Equipment: ® Check this box if tank gauging is used only for inventory control. a 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. a.van tor` 0 Yes � ❑ No* - Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ® Yes 0 No* Were all tank gauging probes visually inspected for damage and residue buildup? 0 Yes ❑ No* Was accuracy of system product level readings tested? D Yes 0 No* Was accuracy of system water level readings tested? ❑ Yes 0 No's Were all probes reinstalled properly? ❑ Yes ❑ No* I 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): 0 Check this box if LLD's are not installed- vvua dl Yes ❑ No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? O N/A (Check all that apply) Simulated leak rate: a 3 g.p.h. (1.); ❑ 0.1 g.p.h. (2.); 0 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. N Yes ❑ No* ]atory requirements? Were all LLD's confirmed =rational and accurate within regu Yes 13 No* Was the testing apparatus properly calibrated? 0 Yes ❑ No* For mechanical LLD's, docs the LLD restrict product flow if it detects a leak? 0 N/A 0 Yes ❑ No* For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak? a N/A 0 Yes ❑ No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is disabled 0 N/A or disconnected? ❑ Yes ❑ No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system 9 N/A malfunctions or fails a test? ❑ Yes ❑ No* For electronic LLD's, have all accessible wiring connections been visually inspected? I N/A ® Yes ❑ No* I 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. IL Comments: Replaced 91 MLLD. Re -tested and passed.