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06 / 28 / 2019 19 : 29 8387674 EMILS PAGE 23 UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM Page 5 of 6 XII . LINE LEAK DETECTOR TESTING ❑ Check this box if line leak defectors (LLD) are NOT Installed . (Do not complete this section.) y N NA This section must be completed if LLUS are Installed Was a leak simulated to verify LLD performance? Q El El (Check ail that apply.) Simulated leak rate verified : ❑X 3 OPH ❑ 0. 11 GPH E] 0.2 GPH Was the testing apparatus properly calibrated ? X ❑ ❑ For emergency generator tank systems , does the LLD create an audible and visual alarm when a leek is detected ? ❑ ❑ For mechanical LLDs, does the LLD restrict the flow through the pipe when a leak is detected? N ❑ ❑ For electronic LLDs , does the turbine automatically shut off when a leak is detected ? El For electronic LLDs , does the turbine automatically shut off if any portion of the monitoring system fa disabled or disconnected ? ❑ � X For electronic LL.Ds , does the turbine automatically shut off if any portion of the monitoring system malfunctions or falls a test? ❑ El X For electronic LLDs, have all accessible wiring connections been vllsually inspected for kinks and breaks? ( ❑ X❑ Wen: all items on the equipment manufacturer's maintenance checklist completed? rz Were all LL Ds confirmed operational within regulatory requiremonls? JN ❑ ❑ For any answer of "N" above, describe in Sectlon Xlll how and when these issvea were or will be corrected_ X111 . COMMENTS XIV. VACUUM / PRESSURE / HYDROSTATIC MONITORING EQUIPMENT TESTING ❑X Check this box if VPH monitoring Is NOT used . (Po not complete this section.) This section must be completed if VPH monitoring is used to perform leak defection monitoring. System Type (Mark all that apply.) ❑ Vacuum ElPressure ❑ Hydrostatic Component(5) Monitored B This sensor Sensor Functionality Interstitial Communication Sensor ID y Test Test ❑ Pass ❑ Fail ❑ Pass Fail �r ❑ Pass ❑ Feil ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass _ ❑ Fail ❑ Pass ❑ Fail Pass ❑ Fail ❑ Pass ❑ Fall Pass ❑ Fail ❑ Pass Fail ❑ Pass OEM Pass ❑ Fail Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fall ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail Pess Faii ❑ 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 ? Ellos ❑ No (Describe the reason in section XV below. For any answer of "f=ail" above, describe in Sectlon 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 = VacvumiPcsssurelHydrostatic, ID = Identification Received Time Jun , 28 . 2019 1 : 27PM No , 5223