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JAN-11-2005 21:13 SERVICE STATION SYSTEM 408 9?1 0135 P.04 <br /> Monitoring System Certification-0 3 of 3 <br /> Site Address: 341 E. Main St. @ Hwy. 99 Date of Testing/Servicing: 1218/04 <br /> F. In-Tank Gauging/SIR Equipment: g 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 /> p Yes a No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> C)Yes p No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ❑Yes p No* Was accuracy of system product level readings tested? <br /> C)Yes p No* Was accuracy of system water level readings tested? <br /> O Yes p No* Were all probes reinstalled properly? <br /> ❑Yes I o No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> In Section Iii below,describe hose and wlwu the4e deridencies were or swill be corrected. <br /> G. Line Leak Detectors(LLD): p Check this box if LLD's are not installed. <br /> Complete the following checklist: • . <br /> ❑Yes j§No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? <br /> C3 N/A (Check all that apply) Simulated leak reale: O 3 g.p.h.(I.); p 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 by local agency,certification required only for electronic LLD start-up. <br /> o Yes a No* Were all LLD's confirmed operational andwcurate within regulatory requirements? <br /> p Yes 19 No* Was the testing apparatus properly calibrated? <br /> 0 Yes ❑No* For mechanical LLD's,does the LLD restrict product flow if it detects a leak? <br /> 0 N/A <br /> o Yes o No* For electronic LLD's,does the turbine automatically shut off if the LLD detects a leak? <br /> 19 N/A <br /> ❑Yes ❑No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> 11 N/A or disconnected? <br /> ❑Yes ❑No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system <br /> H N/A malfunctions or fails a test? <br /> ❑Yes O No* For electronic LLD's,have all accessible wiring connections been visually inspected? <br /> S N/A <br /> 0 Yes Ig No* 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 /> A. Comments: Couldn't do 3 GPH because tester wasn't working correctly. Tested/passed with another technician on <br /> 12/14/04 <br />