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Monitoring System Certification 0 Site Address: 3425 TRACY BLVD F. In -Tank Gauging / SIR Equipment Check this box if no tank gauging or SIR equipment is installed. Date of Testing/Service: 11/26/2008 ❑ 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. Complete the following checklist: E Yes ❑ 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? Q Yes M No • Was accuracy of system product level readings tested? QYes MNo • Was accuracy of system water level readings tested? M Yes ❑ No • Were all probes reinstalled properly? Q Yes ❑No • Were all items on the equipment manufacturers' maintenance checklist completed? - in me 6ecaon M, Mow, aescrlDe now and wnen tnese deticiencieS were or will be Corrected. G. Line Leak Detectors (LLD) : ❑ Check this box if LLDs are not installed. Complete the following checklist: Q Yes ❑ No N/A For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) Simulated leak rate: x 3 h 0.1 h 0.2 h ❑ 9.p. ❑ g.p. ❑ g.p. x Yes ❑ No Were all LLDs confirmed operational and accurate within regulatory requirements? x Yes ❑ No Was the testing apparatus properly calibrated? ❑ Yes ❑ No M N/A For mechanical LLDs, does the LLD restrict product flow if it detects a leak? 0 Yes ❑No • ❑ N/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? M Yes ❑No " ❑ N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? M 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? M Yes ONo • ❑ N/A For electronic LLDs, have all accessible wiring connections been visually inspected? E Yes F-1 No • Were all items on the equipment manufacturers' maintenance checklist completed? 111 UM OV%A1UJI n, ucww, uesarue nuw aria wnen mese oericiencleswere or will De corrected. H. Comments: Page 3 of 3 Based on CA form dated 03/01