COMPLIANCE INFO_2013-2018 DOUBLE CHECK

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MONITORING SYSTEM CERTIFICATION CERTIFICATION /TEST DATE: May 3, 2017 Al. FACILITY A2. OWNER Name Quik Stop Market #120 Name Quik Stop Markets, Inc. Address 9321 Thornton Road, Stockton, CA 95209 Address 4567 Enterprise Street, Fremont, CA 94538 Phone # 510-657-8500 Phone # 510-657-8500 Contact Roger Batra Contact Debbie Markovich F. IN -TANK GAUGING / SIR EQUIPMENT: E 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: * In Section H below, describe how and when these deficiencies were or will be corrected. I; 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* 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* ❑ 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? ❑ Yes ❑ No* Were all items on the * In Section H below, describe how and when these deficiencies were or will be corrected. I; 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* 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* equipment manufacturer's maintenance checklist completed? * In Section H below, describe how and when these deficiencies were or will be corrected. I; 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* 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* * In Section H below, describe how and when these deficiencies were or will be corrected. H. COMMENTS Page 3 of 3 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. H. COMMENTS Page 3 of 3