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UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page s of 6) XIII. LINE LEAK DETECTOR TESTING ❑ Check this box if line leak detectors(LLD)are NOT installed.(Do not complete this section.) Y N NA This section must be completed if LLDs are installed. Was a leak simulated to verify LLD performance? El El El all that apply.) Simulated leak rate verified: N 3 GPH El 0.1 GPH El 0.2 GPH Was the testing apparatus properly calibrated? E ❑ ❑ For emergency generator tank systems,does the LLD create an audible and visual alarm when a leak is detected? ❑ ❑ N For mechanical LLDs,does the LLD restrict the flow through the pipe when a leak is detected? E ❑ ❑ For electronic LLDs,does the turbine automatically shut off when a leak is detected? N ❑ ❑ For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? N ❑ ❑ For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? E ❑ ❑ For electronic LLDs,have all accessible wiring connections been visually inspected for kinks and breaks? E ❑ ❑ Were all items on the equipment manufacturer's maintenance checklist completed? N ❑ ❑ Were all LLDs confirmed operational within regulatory requirements? N ❑ ❑ For any answer of"N"above,describe in section Xlll how and when these issues were or will be corrected. XIV. COMMENTS This station has three Veeder-Root electronic leak detectors for the 87A, 876, and 91 tanks. This station has one FePetro mechanical leak detector for the aboveground additive tank. XV. VACUUM/PRESSURE/HYDROSTATIC MONITORING EQUIPMENT TESTING ❑ Check this box if VPH monitoring is NOT used. (Do not complete this section.) This section must be completed if VPH monitoring is used to perform leak detection monitoring. System Type(Mark all that apply.) E Vacuum ❑ Pressure E Hydrostatic Sensor Functionality Interstitial Communication Sensor ID Component(s)Monitored by this Sensor Test Test S09 87A PRODUCT I INF ®Pass ❑Fail N Pass ❑ Fail S10 87A VAPOR LINE ®Pass ❑Fail E Pass ❑ Fail S11 87A VENT LINE ®Pass ❑Fail E Pass ❑Fail S12 87B PRODUCT I INE ®Pass ❑Fail N Pass ❑ Fail S13 87B SYPHON LINE E Pass ❑ Fail I E Pass ❑ Fail S14 87 VENT LINE N Pass ❑ Fail N Pass ❑ Fail S16 AT P SENSOR N Pass El Fail N Pass ❑ Fail S17 91 PRODUCT LINE N Pass ❑ Fail N Pass ❑ Fail S18 91 VENT LINE E Pass ❑ Fail E Pass ❑ Fail S23 ADDITIVE PRODUCT LINE E Pass ❑ Fail N Pass ❑ Fail S24 ADDITIVE VENT E Pass ❑ Fail E Pass ❑ Fail Li 87A TANK ANNULAR BRINE E Pass ❑ Fail E Pass ❑ Fail L2 87B TANK ANNULAR BRINE E Pass ❑ Fail N Pass ❑ Fail U 91 TANK ANNULAR BRINE N Pass ❑ Fail N Pass ❑ Fail -1-4 91 TANK ANNULAR BRINE N Pass ❑ Fail N Pass ❑ Fail L5 87A TURBINE SUMP BRINE N Pass ❑ Fail E Pass ❑ Fail L6 87A FILL SUMP BRINE N Pass ❑ Fail N Pass ❑ Fail L7 87B TURBINE SUMP BRINE E Pass ❑ Fail E Pass ❑ Fail L8 UNLEADED VENT BOX SENSOR BRINE E Pass ❑ Fail E Pass ❑ Fail L9 87B FILL SUMP BRINE E Pass ❑ Fail N Pass ❑ Fail L10 91 TURBINE SUMP BRINE E Pass ❑Fail E Pass ❑ Fail 1-11 91 FILL SUMP BRINE ®Pass ❑ Fail N Pass ❑ Fail L12 UNLEADED VENT BOX BRINE E Pass ❑ Fail E Pass ❑ Fail L13 ADDITIVE STP SENSOR E Pass ❑ Fail E Pass ❑ Fail L14 I ADDITIVE STE SENSOR BRINE E Pass ❑ Fail E Pass ❑ Fail 15 1 ADDITIVE VENT BOX SENSOR BRINE N Pass ❑ Fail N Pass ❑ Fail L16 ADDITIVE VENT BOX BRINE ®Pass ❑ Fail E Pass ❑ Fail E Pass ❑ Fail E Pass ❑ Fail 1-23. L24 DISP 5&6 BRINE, DISP 7&8 BRINE E Pass ❑ Fail I ® Pass ❑ Fail L25, L26 DISP 9&10 BRINE, DSP 11&12 BRINE E Pass ❑ Fail E Pass ❑ Fail L27. L28 DISE 13&14 BRINE, DISE 15&16 BRINE E Pass ❑ Fail E Pass ❑ Fail How was interstitial communication verified? E Simulated leak at far ends of the interstitial space. E Visual Inspection ❑Other(Describe the method in section XV below.) ❑Gauge Was the vacuum or pressure restored to operating levels in all interstitial spaces? E Yes ❑No(Describe the reason in section XV below.) For any answer of"FAIL"above,describe in section XV how and when these issues were or will be corrected. XVI. COMMENTS GPH=Gallons per hour,Y=Yes,N=No,NA=Not applicable,VPH=Vacuum/Pressure/Hydrostatic,ID=Identification