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Monitoring System Certification-Page 3 of 3 Site Address: 6633 Pacific Ave Date of Testing/Servicing: 3115110 F. In-Tank Gauging/SIR Equipment: M 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 gauging equipment is used to perform leak detection monitoring. Com lets the foliowin checklist. ❑Yes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ❑ Yes ❑ No* Were all tankgauging probes visually inspected for damage and residue buildup? ❑Yes 0 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 equipment manufacturer's maintenance checklist completed? *In Section H below,describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors(LLD): ❑ Check this box if LLD's are not installed. Com lets the follo ing 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 reate:M 3 g.p.h.(1.); 130.1 g.p.h.(2.); 130.2 g.p.h.(2.). Notes: 1. Required for equipment start-up certification and annual certification. 2. Unless mandated b local a enc ,certification re uired onl for electronic LLD start-up. Yes ❑ No* Were all LLD's confirmed operational and accurate within regulatory requirements? 1Cc,1 g Yes ❑ No* Was the testing apparatus properly calibrated? Yes (3 No* For mechanical LLD's,does the LLD restrict product flow if it detects a leak? iX N/A Yes 13 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? B 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? M Yes ❑ No* For electronic LLD's,have all accessible wiring connections been visually inspected? ❑ N/A 1 11 M Yes ❑ No* I 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: