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' 08/05/2003 08:31 1209365 43 TANKNOLOGY PAGE 11/11 <br /> W of <br /> Monitoring System Certification, <br /> Site Address! 1210E. HAMMER LANE Date of Testing/Service: 08/04/2003 <br /> 0 WEST LANE* <br /> P. In—Tank Gauging / d3IR Equipment x❑ Check this box If tank gauging Is used only for inventory control. <br /> ® Check this box if no tank gauging or SM equipment is Installed. <br /> This section must be completed if in-tank gauging equipment is used to perform leak detactlon monitoring. <br /> Complete the £ollamf,ag checklist_ <br /> Yee IDNo Has all Input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> Yes E]No Were all tank gauging probes visually inspected for damage and residue buildup? <br /> MY ffN Was accuracy of system product level readings tested? <br /> ITYcs MNc Was accuracy of system water level readings tested? <br /> x Yea RN. Were all probes reinstalled properly? <br /> Yep ONe 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 /> Lime Leah Detectors (LLD) t <br /> Check this box if LLDs are not installed. <br /> CotPlets the following cheeklista <br /> El Yee CINo ®N/A requpmeniequipment rti caihn,was leasimulated verify LLD perforance?For <br /> that apply)Simulated exgp pk <br /> x Yee ]Dto Were all LLDs confirmed operational and accurate within regulatory requirements? <br /> M Yee ®No Was the testing apparatus properly calibrated? <br /> My"�y" [:]Nn [:]N/A For mechanical LLD$,does the LLD restrict product flow if it detects a leak? <br /> res a. 0 Nie For electronic LLN,does the turbine automatically shut off if the LLD detects a leak? <br /> Q vee ON- N,, For electronic LL®s,does the turbine automatically shut off if any portion of the monitoring System Is disabled or disconnected? <br /> a Yee EINo xM N/A For electronic LLDs,does the turbine automatically shut off If any portion of the monitoring system malfunctions or fails a test? <br /> ElYee �to [D N/A For electronic LLDs,have all accessible wiring connections been visually inspected? <br /> Yax QNo 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 /> N. COMMents: <br /> Asge 3 of 3 <br />