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r <br /> 2098253893 ENGINEERING DEPT. 090 6 a.m. 09-10-2010 21 /21 <br /> M ring System Certification <br /> Site Address: 1777 W YOSEMITE AVE Date of Testing/Service: 08/13/2010 <br /> In-Tank Gauging/SIR Equipment <br /> ❑ 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 /> Check this box if no tank gauging or SIR equipment is instphod. <br /> This section must be completed if in-tank gauging equipment;is used to perform leak detection monitoring. <br /> Complete the following checklist: <br /> ❑Yes ❑No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> ❑Yes ❑No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> ❑Yes ❑No* Was accuracy of syst'm product level readings tested? <br /> ❑Yes ❑No` Was accuracy of sys em water level readings test ? <br /> Yes [:]No* were all probes reinstalled properly? <br /> ®Yes ❑No I Were all items on the equipment manufacturers'maintenance checklist completed? <br /> * below,describe how and when these deficiencies were or will be corrected. <br /> In the Section Hf <br /> G. Line Leak Detectors(LLD) : x❑ Check this box if LLDs are not installed. <br /> Complete the following checklist:;f <br /> For egdipment start-up or annual equipment certification,was a leak simulated to verify LLD performance? <br /> ❑Yes ❑No° E]N/A (Check all that apply)Simulated leak rate: ❑ 3 g.p.hE]0.1 g.p.h ❑0.2 g.p.h <br /> Yes ❑No* Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> C-'Yes [:]NO- Was the testing apparatus pro eriy calibrated? <br /> _j Yes []No*l❑N/A For mechanical LLDs,does the°LLD restrict product flow if it detects a leak? <br /> ❑Yes ❑No° ❑N/A For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? <br /> ❑Yes ❑No* ❑N/A For electronic LLDs,does thekurbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> ❑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? <br /> ®Yes ❑No* ❑N/A For electronic LLDs,:have all accessible wiring connections been visually inspected? <br /> ❑Yes ❑No* Were all items on the equipment manufacturers'maintenance checklist completed? <br /> *In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> H. Comments: <br /> NO LD'S AND TANK GAUGE. <br /> e <br /> Page 3 of 3 Based on CA form dated 03/08 <br />