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Monitoring System Certification <br /> Site Address 401 W_ KETTLEMAN LN <br /> Date of Testing/Service: 11/05/2002 <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 /> M Yes ❑No Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> M Yes 1:1 No Were all tank gauging probes visually inspected for damage and residue buildup? <br /> M Yes []No Was accuracy of system product level readings tested? <br /> MYes O No• Was accuracy of system water level readings tested? <br /> M Yes E]No• Were all probes reinstalled properly? <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 /> G. Line Leak Detectors (LLD) <br /> 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 0 No' N/A (Check all that apply)Simulated leak rate: ® 3 g.p.h❑0.1 g.p.h n0.2 g.p.h <br /> ®Yes FjNoWere all LLDs confirmed operational and accurate within regulatory requirements? <br /> © Yes FjNo Was the testing apparatus properly calibrated? <br /> ®Yes n No• N/A For mechanical LLDs,does the LLD restrict product Flow if it detects a leak? <br /> ❑Yes ❑No• ®N/A For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> Yes ❑No. ®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" ®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 F_jNo• ®N/A For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> MYes r_jNo• 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 /> page 3 of 3 <br />