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®r7 <br /> UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page 5 of s) <br /> XII. LINE LEAK DETECTOR TESTING ' <br /> Check this box if line leak detectors(LLD)are NOT installed.(Do not complete this section.) <br /> This section must be completed if LLDs are installed. ,_ <br /> NVIRD ME <br /> Was a leak simulated to verify LLD performance? r h� El <br /> all that apply.) Simulated leak rate verified: 3 GPH 0.1 GPH 0.2 GPH <br /> Was the testing apparatus properly calibrated? <br /> For emergency generator tank systems,does the LLD create an audible and visual alarm when a leak is detected? <br /> For mechanical LLDs,does the LLD restrict the flow through the pipe when a leak is detected? <br /> For electronic LLDs,does the turbine automatically shut off when a leak is detected? <br /> For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br /> For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> For electronic LLDs,have all accessible wiring connections been visually inspected for kinks and breaks? <br /> Were all items on the equipment manufacturer's maintenance checklist completed? <br /> Were all LLDs confirmed operational within regulatory requirements? I El <br /> 9 F AD <br /> For any answer of"N"above,describe in Section Xlll how and when these issues were or will be corrected. <br /> XIII. COMMENTS <br /> XIV. VACUUM/PRESSURE/HYDROSTATIC MONITORING EQUIPMENT TESTING <br /> Check this box if VPH monitoring is NOT used. (Do not complete this section.) <br /> This section must be completed if VPH monitoring is used to perform leak detection monitoring. <br /> System Type(Mark all that apply.) Vacuum Pressure Hydrostatic <br /> Sensor ID Component(S)Monitored By This Sensor Sensor Functionality Interstitial Communication <br /> Test Test <br /> Pass FjFail P Pass Fail <br /> Pass Fail Pass Fail <br /> Pass OFail Pass Fail <br /> Pass Fail Pass FjFail <br /> Pass Fail Pass Fail <br /> Pass Fail Pass Fail <br /> Pass Fail Pass Fail <br /> Pass Fail Pass Fail <br /> Pass Fail Pass nFail <br /> Pass Fail Pass FjFail <br /> Pass Fail Pass Fail <br /> Pass RFail Pass RFail <br /> How was interstitial communication verified? Simulated Leak at Far Ends of the Interstitial Space Visual Inspection <br /> Other Describe the method in section XV below.) Gau e <br /> Was the vacuum or pressure restored to operating levels in all interstitial spaces? Yes No(Describe the reason in section XV below.) <br /> For any answer of"Fail'above,describe in Section XV how and when these issues were or will be corrected. <br /> XV. COMMENTS <br /> GPH=Gallons Per Hour,Y=Yes,N=No,NA=Not Applicable,VPH=Vacuum/PressurretHydrostatic,ID=Identification <br />