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Site Address: 14971 N HWY 88 <br />Onitoring System Certification 0 <br />Date of Testing/Service: 10/13/2003 <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 />Q Yes <br />❑ No ` <br />Has all input wiring been inspected for proper entry and termination, including testing for ground faults? <br />0 Yes <br />® No ` <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />0 Yes <br />❑ No ` <br />Was accuracy of system product level readings tested? <br />❑X Yes <br />MNo*j <br />Was accuracy of system water level readings tested? <br />FX_1 Yes®No <br />` <br />Were all probes reinstalled properly? <br />❑X Yes <br />❑No ` <br />Were all items on the equipment manufacturers' maintenance checklist completed? <br />In the section H, below, describe now 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 foilowinq checklist: <br />® Yes <br />❑ No <br />For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? <br />❑N/A (Check all that apply) Simulated leak rate: 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 />Fx_j Yes <br />®No ° <br />Was the testing apparatus properly calibrated? <br />❑X Yes <br />®No • <br />® N/A For mechanical LLDs, does the LLD restrict product flow if it detects a leak? <br />❑ Yes <br />❑No ° <br />El N/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />❑ Yes <br />❑No ` <br />® N/A 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 />0 N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br />® Yes❑No <br />` <br />❑x N/A For electronic LLDs, have all accessible wiring connections been visually inspected? <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 />page 3 of 3 <br />