COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM ( Page 5 of 6) XII . LINE LEAK DETECTOR TESTING ❑ Check this box if line leak detectors (LLD) are NOT installed . (Do not complete this section) F[FXK'l N NA This section must be completed if LLDs are installed. Was a leak simulated to verify LLD performance? El (Check all that apply.) Simulated leak rate verified : ❑X 3 GPH E] 0. 1 GPH El 0. 2 GPH Was the testing apparatus properly calibrated ? ❑ ❑ For emergency generator tank systems , does the LLD create an audible and visual alarm when a leak is detected ? ❑ ❑ XQ For mechanical LLDs , does the LLD restrict the flow through the pipe when a leak is detected ? Q ❑ ❑ For electronic LLDs , does the turbine automatically shut off when a leak is detected ? ❑ ❑ For electronic LLDs , does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? ❑ ❑ X❑ For electronic LLDs , does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? ❑ ❑ XQ For electronic LLDs , have all accessible wiring connections been visually inspected for kinks and breaks? ❑ ❑ 0 Were all items on the equipment manufacturer's maintenance checklist completed ? 0 ❑ ❑ Were all LLDs confirmed operational within regulatory requirements? z ❑ ❑ For any answer of "N" above, describe in Section Xlll how and when these issues v era2 or_ will:be corrected4 3- w . XIII . COMMENTS ; 13 �A q XIV. VACUUM / PRESSURE / HYDROSTATIC MONITO t - fl. 0,�M f T , , TING " k k , �_, i 'i. 1. ❑X Check this box if VPH monitoring is NOT used . (Do not complete this section) j This section must be completed if VPH monitoring is used to perform leak detection monitoring. System Type (Mark all that apply.) ❑ Vacuum ❑ Pressure ❑ Hydrostatic i Sensor ID Component(S) Monitored By This Sensor Sensor Teionality Interstitial CT Smunication st r ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail El Pass El Fail ❑ Pass E] Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail I ❑ Pass ❑ Fail ❑ Pass ❑ Fail I ❑ Pass ❑ Fail ❑ Pass ❑ Fail I ❑ Pass ❑ Fail How was interstitial communication verified ? ❑ Simulated Leak at Far Ends of the Interstitial Space ❑ Visual Inspection ❑ Other (Describe the method in section XV below) ❑ Gauge Was the vacuum or pressure restored to operating levels in all interstitial spaces? ❑ 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. XV. COMMENTS GPH = Gallons Per Hour, Y = Yes, N = No, NA = Not Applicable, VPH = VacuumlPressure/Hydrostatic, ID = Identification