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Monitoring System Certification Site Address: 1777 W YOSEMITE AVE Date of Testing/Service: 08/30/2007 F. In -Tank Gauging / SIR Equipment ❑ Check this box if tank gauging is used only for inventory control. ❑X 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: ❑ 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? ❑ Yes ❑No * Was accuracy of system product level readings tested? ❑Yes ❑ No * Was accuracy of system water level readings tested? ❑ Yes ❑ No * Were all probes reinstalled properly? tYesYes ❑ No * Were all items on the equipment manufacturers' maintenance checklist completed? * In the Section H, below, describe now ana when mese oerncienues weie vi will ue wncucu. G. Line Leak Detectors (LLD) : ❑x Check this box if LLDs are not installed. r- !-6- •F.e ❑ Yes ❑ No * 4..IIn•uinn nhnr41ic4• r v ❑ 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: ❑ 3 g.p.h ❑ 0.1 g.p.hE]0.2 g.p.h Yes ❑ No * Were all LLDs confirmed operational and accurate within regulatory requirements? Yes ❑No* Was the testing apparatus properly calibrated? ❑ Yes ❑ No * ❑ N/A For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ Yes ❑No * ❑ N/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑ Yes ❑No * ❑ N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? ❑ 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? ❑ Yes ❑No * ❑ N/A For electronic LLDs, have all accessible wiring connections been visually inspected? Yes ❑No * Were all items on the equipment manufacturers' maintenance checklist completed? * In the Section H, below, describe now ana wren mese aericienues were vi will — —11-- H. 11— . H. Comments: Page 3 of 3 Based on CA form dated 03/01