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JAN-11-2005 21:14 SERVICE STATI❑N SYSTEM 408 971 0135 P.07 Monitoring System Certification-PA93 of 3 Site Address. 341 E.Main St._�Hwy.99 Date of'Testing/&Kvicing: '! 4 F. In-Tank Gauging/SIR Equipment: 0 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. Co Tete the following checklist: D Yes ❑No* Has All input wiring bccn inspected for proper entry and termination,including testing for ground fauns? ❑Yes ❑No* Were all tank gauging probes visually inspected for damage and residue buildup? ❑Yes D No* Was accuracy of system product level readings tested'? D Yes D No* Was accuracy of system water level readings tested? D Yes D No* Were all probes reinstalled properly? 0 Yes 0 No* 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): p Check this box if LLD's are not installed. Complete the following checklist: ?1'Yes 0 No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD performance? ❑N/A (Check all that apply) Simulated leak reate:fit 3 g.p.h.(1.); © 0.1 g.p.h.(2.); D 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. ,Rf Ycs D No* Were all LLD's confirmed operational and accurate within re ulatory requirements? ,ErYes D No* Was the testing apparatus properly calibrated? ❑Yes ❑No* For mechanical LLD's,does the LLD restrict product flow if it detects a leak? N/A ,EPYes ❑ No* For electronic LLD's,does the turbine automatically shut off if the LLD detects a leak? ❑N/A QIl . * r r,'_ a .��_ �.:, y� LS ❑�10 �"t�i"k'14'C�A t7iIiC LUD'S �,vW3 iu4, tt.i otitc,1Y�t4iI17tzv�lily S19iI`t off if Gray PCtt lil9rl Qf tl1C 7TlOilitCail77b syste➢"i'!3S(�i Sc�UlFiCi ❑N/A or disconnected? Yes 11 No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system ❑N/A malfunction-,or fails a test? Yes El No* For electronic LLD's, have all accessible wiring connections been visually inspected? ❑ N/A L2ze=s= ❑ No* 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. D. Comments: