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a <br /> MONITORING SYSTEM CERTIFICATION, <br /> S E P 29, "r,017 <br /> CERTIFICATION /TEST DATE: September 20, 2017 <br /> A1. FACILITY A2. OWNER t z <br /> Name Teichert Mobile Equipment Name Teichert Construction <br /> Address 120 Frank Circle,Stockton,CA 95206 Address P.O.Box 15002,Sacramento,CA 95851 <br /> Phone# 916-366-8631 Phone# 916-386-3767 <br /> Contact Steve Schamaun Contact Steve Schamaun <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 gam <br /> gung 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 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* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> * In Section H below,describe how and when these deficiencies were or will be corrected. <br /> G. LINE LEAK DETECTORS (LLD): ❑ Check this box if LLDs are not installed. <br /> Complete the following checklist: <br /> ■ Yes ❑ No* For equipment start-up or annual equipment certification,was a leak simulated to verify LLD performance? <br /> ❑ N/A (check all that apply) Simulated leak rate: ■ 3 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 disabled <br /> ❑ N/A or disconnected? <br /> ■ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions <br /> ❑ N/A or fails a test? <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 Section H below,describe how and when these deficiencies were or will be corrected. <br /> H. COMMENTS <br /> ©2017 Walton Engineering,Inc. <br /> Page 3 of 3 <br />