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Jun, 2b. 2020 3:39PM Donlee Pump Co No. 4053 P. b UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page s of s) XII. LINE LEAK DETECTOR TESTING Li Check this box If line leak detectors(LLD)are NOT installed.(Do not complete this secilon,) Y N NA Thfs section must be completed If LLDs are installed. Was a leak simulated to verify LLD performance? ,,f 171 ❑ Check all that apply,) Simulated leak rate verified: 03 GPH El 0.1 GPH ❑0.2 GPH YI Was the testing apparatus properly calibrated? ❑ ❑ For emergency generator lank systerns,does the LLD create an audible and visual alarm when a leak Is detected? ❑ ❑ For mechanical LLDs,does the LLD restrict the flow through the pipe when a leak IS detected? ❑ ❑ For electronic LLOs,does the turbine automatically shut off when a leak is detected? ❑ Ij For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? ❑ U For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or faits a test? ❑ (71 For electronic LLDs,have all accessible wiring wnnectionS been visually Inspected for kinks and breaks? ❑ ❑ Were all items on the equipment manufacturers maintenance checklist completed? ❑ ❑ Were all LLDs conFirrned operational within regulatory requirements? ❑ ❑ For any answer of"N"above,describe in section Xlll how and when these Issues were or will be corrected. XIII. COMMENTS �i,&-b 9) `IEIXTA4Y-.>ti T Lb c4Lrt3e,.re! l,h resTe'p XIV. VACUUM/PRESSURE/HYDROSTATIC MONITORING EQUIPMENT TESTING 0—Check this box if VPH monitoring is NOT used. (Do not complete this section.) This sectlon must be completed If VPH monlior(ng Is used to perform leak detection monitoring. System Type(Ma(k all that apply.) ❑Vacuum 0 Pressure ❑Hydrostellc Sensor Functionality Interstitial Communication Sensor ID Component(s)Monitored by this Sensor Test Test ❑Pass ❑Fail ❑Pass ❑Fail ❑Pass ❑Fail ❑Pass ❑Fail ❑Pass ❑Fail ❑Pass ❑Fail ❑Pass ❑Fall ❑Pass ❑Fail ❑Pass ❑Fail ❑Pass ❑FAII ❑Pass ❑Fail I]Pass ❑Fail ❑Pass ❑FAII ❑Pass ❑Fait v ❑Pass El Fail ❑ ass ❑Fall ❑Pass ❑Fail ❑Pass ❑Fail ❑ Pass ❑Fall ❑Pass ❑Fail ❑Pass I]Fail ❑Pass ❑Fall ❑Pass ❑Fail ❑Pass ❑Fall How was interstitial communication verified? ❑Simulated teak at far ends of the interstitial space. Visual Inspection ❑Other(Describe the method hr sectfon X11 below.) ❑Gauge Was the Vacuum or pressure restored to operating levels in all interstitial spaces? ❑Yes ❑No(DesCnbe the reason in section XV below.) For anv answer of"FAIL"above,describe in section XV how and when these Issues were or will be corrected. XV. COMMENTS GPH=Gallons per hour,Y=Yes,N=No,NA�Not applicable,VPH=VacuunvPrmura Nydrostadc,ID o Identification