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MAR-24-2010 08:18 Service Station Systems 408 938 8888 P.05 <br /> I <br /> Monitoring I System Certification-Pug 3 <br /> Site Address- 401 W. Kettleman Ln. Date of Testing/Servicing: 2124110 <br /> F. In-Tank Gauging I SIR Equipment: cl check this box if tank gauging is used only for inventory control. <br /> 13 Check this box if no tank gaughigOTSIR equipment is installed. <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. <br /> Com lets the Mowing checklist; <br /> 0 yes -C3 No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> 13 Yes a No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> o Yes 0 No* Was accuracy of system product level readings tested? <br /> a Yes 0 No* Was accuracy of system water level readings tested? <br /> a Yes 13 No* I were all probes reinstalled property? <br /> o yes E3 No*_1 Were all items on the equipment manufacturer's maintenance checklist completed? <br /> In Section H below,describe how and when these deficiencies were or will be corrected. <br /> G. Line Leak Detectors(]LLD): 0 Check this box if LLD's are not installed. <br /> Cpm lets the following checklist: - .1) <br /> *yes a No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? <br /> 0 N/A (Check all that apply)ply) Simulated leak reate:IX 3 g.p.h.(I.); M 0.1 g.p.h.(2,),, 0 0.2 g.p.h_(2.). <br /> Notes- 1. Required for equipment start-up certification and annual certification, <br /> 2. Unless mandated!?Z local agency,certification required only for electronic LLD start-up. <br /> IS Yes 1 0 No* Were all LLD's confirmed operational and accurate within regulato!j requirements? <br /> (X Yes a No* Was the testin&apparatus pro RS Ul calibrated? <br /> la Yes 13 No* For mechanical LLD's,does the LLD restrict product flow if it detects a leak? <br /> El N/A <br /> 0 Yes Cl No* For electronic LLD's,does the turbine automatically shut off if the LLD detects a leak? <br /> M N/A <br /> Ei Yes 0 No* for electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> M N/A or disconnected? <br /> 0 Yes 0 No* For electronic LLD's, does the turbine automatically shut off ifanyportion of the monitoring system <br /> 11 N/A malfunctions or fails a test? <br /> 13 Yes 13 No* For electronic LLD's,have all accessible wiring connections been visually inspected? <br /> ix N/A <br /> 11 Yes 0 NO Were all items on the equipment manufacturefs maintenance checklist completed? <br /> In­Section H below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br />