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Monitoring System Certification-Page 3 of 3 Site Address: 6633 Pacific Ave Date of Testing/Servicing D/7/I 1 F. In-Tank Gauging/SIR Equipment: ❑ Check this x if tank gauging is used only for inventory control. ❑ Check box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipme is used to perform leak detection monitoring. Com lets the followin checklist: ❑ Yes ❑ No* Has all input wiring been inspected f proper ehtry and termination,including testing for ground faults? ❑ Yes ❑ No* Were all tank gauging probes A ly inspected for damage and residue buildup? ❑ Yes ❑ No* Was accuracy of system p act level readings tested? [3 Yes E3 No* Was accuracy of sy r level readings tested? ❑ Yes I ❑ No* Were all probes ' stalled properly? ❑ Yes ❑ No* Were all its on the equipment manufacturer's maintenance checklist completed? *In Section H below,describe 6ow and when these deficiencies were or will be corrected, G. Line Leak Detectors(LLD): 49 Check this box if LLD's are not installed. Com late the followin checklist: S Yes 9-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 reate-il.-3 g.p.h.(L); ❑ 0.1 g.p.h.(2.); ❑ 0.2 g.p.h.(2.). Notes: 1. Required for equipment start-up certification and annual certification. 2. Unless mandated by local agency,certification required only for electronic LLD start-up. 4 Yes ❑ No* Were all LLD's confirmed ional and accurate within relata irements? 42-Yes ❑ No* Was the testing!Waratus properly calibrated? ❑ Yes ❑ No* For mechanical LLD's,does the LLD restrict product flow if it detects a leak? *N/A C7-Yes ❑ No* For electronic LLD's,does the turbine automatically shut off if the LLD detects a leak? ❑ N/A Yes ❑ No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system is disabled ❑ N/A or disconnected? Yes ❑ No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system ❑ N/A malfunctions or fails a test? a Yes ❑ No* For electronic LLD's,have all accessible wiring connections been visually inspected? ❑ N/A Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist com leted? *In Section H below,describe how and when these deficiencies were or will be corrected. H. Comments: