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Underground Storage Tank <br /> Monitoring System Certification Form <br /> 8. IN-TANK GAUGING TESTING <br /> ® Check this box if tank gauging is used only for inventory control. <br /> ❑ Check this box if NO tank gauging equipment is installed. Yes No NA <br /> Do not complete this section if either box is checked. <br /> All wiring has been: 1) visually inspected for kinks, breaks and proper entry and ® ❑ ❑ <br /> termination; and 2 tested for ground faults? <br /> Were all in-tank gauging probes visually inspected for damage and residue buildup ® ❑ ❑ <br /> to ensure that floats move freely, functionally tested, and confirmed operational? <br /> Was accuracy of system's product level readings tested? ® ❑ ❑ <br /> Was accuracy of system's water level readings tested? ® ❑ ❑ <br /> Were all probes reinstalled properly? ® ❑ ❑ <br /> Were all items on the equipment manufacturer's maintenance checklist completed? ® —P—L ❑ <br /> Probe ID Probe Model Tanks Monitored Pass Fail <br /> T-191 VR-Mag-1 T-191 ® ❑ <br /> T-2 87 Aux VR-Mag-1 T-2 87 Aux ® ❑ <br /> T-3 87 Main VR-Mag-1 T-3 87 Main ® ❑ <br /> T-4 Diesel VR-Mag-1 T-4 Diesel ® ❑ <br /> 9. COMMENTS <br /> Describe all answers marked "No"or "Fail"and proposed remedy. <br /> List all monitoring equipment either replaced or repaired. <br /> UDC's are equipped with sensors for positive shutdown only at the dispensers. The 91 <br /> Leak detector was adjusted 3 time then passed. <br /> Dispenser#9-10 VR-001 sensor failed. Repairs were made on 8-4-22 by Richard Thomas. <br /> ICC#5254736 Veeder Root #1334022. Sensor replaced like for like and Passed. <br /> Emergency Shut-Off "ESO" Testing Results & Checklist: <br /> Site Data: <br /> How many ESO switches are present onsite? _1 <br /> Performance Test: <br /> 1. Does the ESO shutdown power to dispensers? Yes ® No ❑ <br /> 2. Does the ESO shutdown power to the STPs? Yes ® No ❑ <br /> Post Test: <br /> Is site's fueling equipment operational? Yes ® No ❑ <br /> Page 5of6 <br />