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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page s of 6) <br /> XII. LINE LEAK DETECTOR TESTING <br /> ❑Check this box if line leak detectors(LLD)are NOT installed.(Do not complete this section.) Y N NA <br /> This section must be completed if LLDs are installed. <br /> Was a leak simulated to verify LLD performance? <br /> Check all that apply.) Simulated leak rate verified: X 3 GPH ❑ 0.2 GPH ❑ ❑ <br /> ( pp y.) ❑ ❑ 0.1 GPH <br /> Was the testing apparatus properly calibrated? Q ❑ ❑ <br /> For emergency generator tank systems,does the LLD create an audible and visual alarm when a leak is detected? ❑ ❑ Q <br /> For mechanical LLDs,does the LLD restrict the flow through the pipe when a leak is detected? ❑X ❑ ❑ <br /> For electronic LLDs,does the turbine automatically shut off when a leak is detected? ❑ ❑ Q <br /> For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? ❑ ❑ X❑ <br /> For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? ❑ ❑ Q <br /> For electronic LLDs,have all accessible wiring connections been visually inspected for kinks and breaks? ❑ ❑ 0 <br /> Were all items on the equipment manufacturer's maintenance checklist completed? ❑X ❑ ❑ <br /> Were all LLDs confirmed operational within regulatory requirements? Q ❑ ❑ <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 /> Replaced FE PETRO MLLD with VMI 99 LD-2000 due to old MLLD not detecting leak. - <br /> Old: FE PETRO S#- 19C501400354L <br /> New: VMI 99LD-2000 S#- 18021403 <br /> XIV. VACUUM/PRESSURE/ HYDROSTATIC MONITORING EQUIPMENT TESTING <br /> ❑X 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 ❑Fail ❑Pass ❑Fail <br /> ❑Pass ❑Fail ❑Pass ❑Fail <br /> ❑Pass ❑Fail ❑Pass ❑Fail <br /> ❑Pass ❑Fail j ❑ Pass ❑Fail <br /> ❑ Pass ❑Fail ❑ Pass ❑Fail <br /> ❑ Pass ❑Fail ❑ Pass ❑Fail <br /> ❑ Pass ❑Fail ❑ Pass ❑Fail <br /> ❑ Pass ❑Fail ❑ Pass ❑ Fail <br /> ❑ Pass ❑Fail ❑ Pass ❑Fail <br /> ❑ Pass ❑Fail ❑ Pass ❑Fail <br /> ❑Pass ❑Fail ❑ Pass ❑Fail <br /> ❑ Pass ❑Fail ❑ Pass ❑Fail <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.) ❑Gauge <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=VacuumlPressure/Hydrostatic,ID=Identification <br />