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MONITCVING SYSTEM CERTIFfATION SEP 21 2015 CERTIFICATION / TEST DATE: September 11, 2015 9nlr®IRnN11ACAl A1. FACILITY A2. OWNER -a, -13 na Name Teichert Mobile Equipment Name Teichert Construction Address 120 Frank Circle, Stockton, CA 95206 Address P.O. Box 15002, Sacramento, CA 95851 Phone # 916-366-8631 Phone # 916-386-3767 Contact Steve Schamaun I L Contact Steve Schamaun F. IN -TANK GAUGING / SIR EQUIPMENT: ■ 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 gaugung 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 ail 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? Were all probes reinstalled properly? ■ Yes ❑ No* ■ Yes tEl 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): ❑ Check this box if LLDs are not installed. Complete the following checklist: ■ Yes ❑ 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 rate: ■ 3 g.p.h.; ❑ 0.1 g.p.h.; ❑ 0.2 g.p.h. ■ Yes ❑ No* I Were all LLDs confirmed operational and accurate within regulatory requirements? ■ Yes ❑ No * Was the testing apparatus properly calibrated? ❑ Yes ❑ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ■ N/A ■ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑ N/A ■ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled ❑ N/A or disconnected? ■ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions ❑ N/A or fails a test? ■ Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? ❑ N/A ■ Yes ❑ 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. Page 3 of 3