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MaRitoring System Certification <br />Site Address: 2501 E JACKSON AVE <br />F. In -Tank Gauging / SIR Equipment <br />v <br />Date of Testing/Service: 07/21/2005 <br />❑ 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 gauging equipment is used to perform leak detection monitoring. <br />Complete the following checklist: <br />Yes <br />[-,]No ' <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />❑ Yes <br />QNo ` <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />® Yes <br />❑No * <br />Was accuracy of system product level readings tested? <br />❑ Yes <br />❑ No * <br />Was accuracy of system water level readings tested? <br />Fj Yes <br />F]No * <br />Were all probes reinstalled properly? <br />Yes <br />[--]No * <br />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 />G. Line Leak Detectors (LLD) : ❑ Check this box if LLDs are not installed. <br />Complete the following checklist: <br />Q Yes <br />[:] No * <br />F-1 N/A <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />(Check all that apply) Simulated leak rate: Q 3 g.p.h ❑ 0.1 g.p.h ❑0.2 g.p.h <br />FX -1 Yes <br />❑ No * <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />FXYes <br />❑ No * <br />Was the testing apparatus properly calibrated? <br />® Yes <br />F� No * <br />❑ NtA <br />For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ Yes <br />FIN, * <br />❑x N/A <br />For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />❑ Yes <br />❑No * <br />❑x NIA <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br />❑ Yes <br />❑No * <br />Q N/A <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br />❑ Yes <br />❑No * <br />0 N/A <br />For electronic LLDs, have all accessible wiring connections been visually inspected? <br />I_J Yes <br />❑No * <br />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 />H. Comments: <br />small amt of water in all stp's (all 3 equal about 5 gal) <br />Page 3 of 3 Based on CA form dated 03/01 <br />