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07/24/2003 12:44 4089710 5 SSS INC PAGE 05 Monitoring,System Certification-Page 3 of 3 Site Address: 2375 W. Grant Line 0..1-205 Date of Testing/Servicing: 06/03/03 F. In-Tank Gauging/SIR Equipment'. M Check this box if tank gauging is used only for inventory control. ❑ (;heck this box if no tank gauging or SIR equipment.iti installed. This section must be e.omPk-I i if in-tank gauging equipment is used to perform leak detectioli monitoring. COEn Icte the foilint,checklist: ❑Yes D No* 11as all input wiring been inspected for proper entry and termination,including testing for ground faults Q Yes ❑No* Were all tank gauging probes visually inspected for damage and residue buildup? ❑Yes ❑ No* Was accuracy of system product level readings tested'? ©Yes ❑ Noy Was accuracy of system water levet readings tested? ®Yes © No* Were all probes reinstalled.properly? ®Yes ❑ No's Were all items on the equipment manufacturers maintenance:checklist completed? *In Section.9 below,describe bow and when these deficiencies were or will be corrected. G. .Line Leak Detectors (LLD)- 0 Check this box if LLD's are not installed. Com lets the followin checklist- ®Yes ❑No* For equipment start-up or annual equipment certification was a leak simulated to verify LLD pciforn=cc? tl N/A (Check all that apply) Simulated leak reate: ® 3 g,p.h.(1.); a 0.1 g.p.h.(2.); 0 0.2 g.p.h.(2.). Notes: 1, Required for equipment dart-np certification and annual certification. 2. Unless mandated b local agenc ,certification re uired only for electronic LLD start-up. ®Y Yes es 0 No* Were all LLD's confirmed o rational and accurate within regulatory requirements? a 13 No* Was the testing apparatus proper! calibrated'' ❑Yes 11 No* For mechanical LLD's,does the LLD restrict product flow if it detects a leak? M NI M Yes 0 No* For electronic LLD's,does the turbine automatically shut off if the LLD detects a leak'? ❑ N/A 10 Yes 13 No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system is disabled ®NIA or disconnected'? 0 Yes 13 No* For electronic LLD's,does the turbine automatically shut off if any poniuu of aiv��o., itoring system ❑N/A malfunctions or fails a test'? q,yes ❑ No* For electronic LLD's,have all accessibly wiring connections been visually inspected? ❑N/A L Yes ❑No's 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. F)f. Comments: