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aitoring System Certification do <br />Site Address: 1617 W. FREMONT <br />F. In -Tank Gauging / SIR Equipment <br />Check this box if no tank gauging or SIR equipment is installed. <br />Date of Testing/Service: 09/24/2009 <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 />0 Yes <br />❑No * <br />Were all tank gauging probes visually inspected for damage and residue buildup? <br />MYes <br />❑No * <br />Was accuracy of system product level readings tested? <br />❑x Yes <br />❑ No * <br />Was accuracy of system water level readings tested? <br />x Yes <br />❑ No * <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 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 />M 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: Q 3 g.p.h ❑ 0.1 g.p.h ❑0.2 g.p.h <br />FTJ Yes <br />❑ No * <br />Were all LLDs confirmed operational and accurate within regulatory requirements? <br />Fxj Yes <br />F_� 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 />0 Yes <br />❑No ^ <br />❑ N/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? <br />MYes <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 />M Yes <br />❑No * <br />❑ N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br />Q Yes <br />[:]No* <br />❑ N/A For electronic LLDs, have all accessible wiring connections been visually inspected? <br />17711 <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 deticlencles were or will be corrected. <br />H. Comments: <br />Page 3 of 3 Based on CA form dated 03101 <br />