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y JUL-04-2011 09:53 Service Station Systems 408 938 8888 P.10 Monitoring System Certification-Page 3 of 3 Site Address; 2375 W.Grant Line Date of Testing/Servicing: 6/10/11 F. In -Tank Gauging/SIR Equipment., Check this box if tank gauging is used only for inventory control. C3 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 perform leak deflection monitoring. Com tete the foil ina checklist: ❑ Yes ❑ No* Has all input wiring been inspected for proper entry and termination,i uding testing for ground faults? Q Yes ❑ No* Were all tank gauging probes visually inspected for damage and re ' ue buildup? ❑ Yes ❑ No* Was accuracy of system product level readings tested? ❑ Yes ❑ No* Was accuracy of system water level readings tested? ❑ Yes Q No* Were all probes reinstalled properly? ❑ Yes ❑ No* Were all items on the equipment manufacturer's rn enance checklist completed? * in Section H below,describe how and when these deficiencies re or will be corrected. G. Line Leak Detectors(LLD), Check this box if LLD's are not installed. Com lets the foilowin checklists ❑ Yes ❑ No* For equipment start-up or ann equipment certification was a leak simulated to verify LLD performance? fl N/A (Check all that apply) Si seed leak rate: Q 3 g.p.h.(1.); ❑ 0.1 g.p.h.(2.); ❑ 0.2 g.p.h.(2.). Notes: 1. Required equipment start-up certification and annual certification. 2. Unless andated by local agency,certification a uired only for electronic LLD start-up, ❑ Yes ❑ No* Were all LLD's c firmed o erational and accurate within reg!4latory regulatoryrequirements'? C3 Yes ❑ No* Was the testi apparatus Er22erlZ calibrated? ❑ Yes ❑ No* For meek seal LLD's,does the i.LD restrict product flow if it detects a leak? ❑ N/A ❑ Yes ❑ No* For ectronie LLD's,does the turbine automatically shut off if the LLD detects a leak? ❑ N/A ❑ Yes ❑ Noy Arorelectronic LLD's,does the turbine automatically shut off if any portion ofthc monitoring system is disabled ❑ N1A,1 or disconnected? Q Yes ❑ o* For electronic LLD's,does the turbine automatically shut off if any portion of the monitoring system N/A malfunctions or fails a test? Q Yes ❑ No* for electronic LLD's,have all accessible wiring connections been visually inspected? LILN/A No* I Were all items on the equipment manufacturer's maintenance checklist completed? *In Section HI below,describe how and when these deficiencies were or will be corrected, H. Comments; TLM's and LUD's are monitored by Veeder Root TOTAL P.10