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MONIT ING SYSTEM CERTIFOATION CERTIFICATION / TEST DATE: Mav 05, 2014 F. IN -TANK GAUGING / SIR EQUIPMENT: ❑ 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 gaugung equipment is used to perform leak detection monitoring. Complete the following checklist: Yes ElNo* � ❑ Yes ❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ❑ No * Was accuracy of system product level readings tested? 13 Yes ❑ No * Was accuracy of system water level readings tested? ❑ Yes ❑ No * Were all probes reinstalled properly? ❑ Yes El No * Were all items on the equipment manufacturer's maintenance checklist completed? ❑ Yes ElNo* El N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled ❑ Yes ❑ No* El N/A or disconnected? El Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions El N/A or fails a test? For electronic LLDs, have all accessible wiring connections been visually inspected? El Yes * In Section H below, describe how and when these deficiencies were or will be corrected. n Section H below, describe how and when these deficiencies were or will be corr Yes ElNo* � ❑ Yes ❑ No * Were all tank gauging probes visually inspected for damage and residue buildup? El Yes ❑ No * Was accuracy of system product level readings tested? 13 Yes ❑ No * Was accuracy of system water level readings tested? ❑ Yes ❑ No * Were all probes reinstalled properly? ❑ Yes El No * Were all items on the equipment manufacturer's maintenance checklist completed? G. LINE LEAK DETECTORS (LLD): El Check this box if LLDs are not installed. Complete the following checklist: ❑ Yes ElNo* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? El N/A (check all that apply) Simulated leak rate: ■ 3 g.p.h.; ❑ 0.1 g.p.h.; ❑ 0.2 g.p.h. El Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? El Yes ❑ No* Was the testing apparatus properly calibrated? El Yes ❑ No* For mechanical LLDs, does the LLD restrict product flow If it detects a leak? [I N/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑ Yes ElNo* El N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled ❑ Yes ❑ No* El N/A or disconnected? El Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions El N/A or fails a test? For electronic LLDs, have all accessible wiring connections been visually inspected? El Yes ❑ No* ❑ N/A Were all items on the equipment manufacturer's maintenance checklist completed? ❑ Yes ❑ No* H. COMMENTS Page 3 of 3 ected.