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Monitoring System Certification <br /> Address: 124 W. ELM ST. LODI 95240 Service Date: 05/03/2011 <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 fol owing checklist <br /> ❑Yes ❑No* Has all input wiring been inspected for proper entry and termination, including testing for ground <br /> faults? <br /> ❑Yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ❑Yes ❑ No* Was accuracy of system product level readings tested? <br /> ❑Yes ❑ No* Was accuracy of system water level readings tested? <br /> ❑Yes ❑ No* Were all probes reinstalled properly? <br /> ❑Yes ❑ No* I Were all items on the equipment manufacturer's 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): M Check this box if LLDs are not installed <br /> Complete the fol owina checklist <br /> ❑Yes ❑No* For equipment start-up or annual equipment certification,was a leak simulated to verify LLD <br /> performance? <br /> ❑N/A Simulated Leak Rate(check all that apply) ❑3.0 g.p.h ❑0.1 g.p.h ❑0.2 g.p.h <br /> ❑Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> ❑Yes ❑ No* Was the testing apparatus properly calibrated? <br /> ❑Yes ❑ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br /> ❑ N/A <br /> ❑Yes ❑No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br /> ❑N/A <br /> ❑Yes ❑No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is <br /> disabled or disconnected? <br /> ❑N/A <br /> ❑Yes ❑No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system <br /> malfunctions or fails a test? <br /> ❑ N/A <br /> ❑Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? <br /> ❑N/A <br /> ❑Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> *In the Section H below, describe how and when these deficiencies were or will be corrected <br /> H. Comments <br /> Suction system <br /> Monitoring System Certification Page 3 of 4 12/07 <br /> 3 2/21/07 <br />