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JUL-04-2011 09:51 Service Station Systems 408 938 8888 P.05 Monitoring System Certification-Page 3 of 3 Site Address: 2375 W.Grant Line Date of Testing/Servicing: 6/10111 F. In -Tank Gauging/SIR Equipment; 0 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 perforin leak detection monitoring. Com lets the following checklist; 0 Yes p No* Has all input wiring;been inspected for proper entry and termination,including testing for ground faults? 13 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 ❑ No* Was accuracy of system water level readings tested? ® Yes ❑ No* Were all probes reinstalled properly? ® Ycs ❑ 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 following checklist: 0 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 rate: 0 3 g.p.h.(1.); 0 0.l g.p.h.(2.); ❑ 0.2 g.p.h.(2.). Notes: 1. Required for equipment start-up certification armed annual certification. 2. Unless mandated t local Sency,certification required only for electronic LLD start-up. 8 Yes 0 No* Were all LLD's confirmed o erational and accurate within regulatory requirements? M Yes ❑ No* Was the testing a aratus Eroeerl calibrated? D Yes C No* For mechanical LLD's,does the LLD restrict product flow if it detects a leak? a N/A M Yes ❑ No* For electronic I.I,D's,does the turbine automatically shut off if the LLD detects a leak? ❑ N/A 8 Yes R No* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system is disabled r9 MIA nr Mannnnanto-A9 2 Yes D 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? ® Yes 0 No* For electronic LLD's,have all accessible wiring connections been visually inspected? ❑ N/A a Yes I O 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: