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UNDERGROUNDSTORAGETANK <br /> MONITORING SYSTEM CERTIFICATION FORM <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? El ❑ ❑ <br /> Check all that apply.) Simulated leak rate verified: 2 3 GPH ❑0.1 GPH ❑0.2 GPH <br /> Was the testing apparatus properly calibrated? 0 ❑ ❑ <br /> For emergency generator tank systems,does the LLD create an audible and visual alarm when a leak is detected? El ❑ ❑ <br /> For mechanical LLDs,does the LLD restrict the flow through the pipe when a leak is detected? El ❑ ❑ <br /> For electronic LLDs,does the turbine automatically shut off when a leak is detected? ❑ ❑ 0 <br /> For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? ❑ ❑ El <br /> For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? ❑ ❑ (i] <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? D ❑ ❑ <br /> Were all LLDs confirmed operational within regulatory requirements? ❑ ❑ <br /> For any answer of"M'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 Functionality Interstitial Communication <br /> Sensor ID Component(s)Monitored by this Sensor Test Test <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 /> ❑ Pass ❑Fail ❑Pass ❑Fail <br /> ❑ Pass ❑Fail ❑Pass ❑ Fail <br /> ❑Pass ❑Fail ❑Pass ❑Fail <br /> ❑Pass ❑Fail I ❑Pass ❑ Fail <br /> How was interstitial communication verified? ❑Simulated leak at far ends of the interstitial space. Lj 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=Vacuum/Pressure/Hydrostatic,ID=Identification <br />