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UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM XII , LINE LEAK DETECTOR TESTING ❑ Check this box if line leak detectors ( LLD) are NOT installed . (Do not complete this section.) Y N N /A This section must be completed if LLDs are installed. ® El ElWas a leak simulated to verify LLD performance? (Check all that apply.) Simulated leak rate verified : ® 3 GPH ❑ 0. 1 GPH ❑ 0 . 2 GPH Was the test apparatus properly calibrated ? ® ❑ ❑ For emergency generator tank systems, 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 ? ❑ El For electronic LLDs, does the turbine automatically shut off when a leak is detected ? ® El El For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or ® ❑ ❑ disconnected ? For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a ® ❑ ❑ test? For electronic LLDs, have all accessible wiring connections been visually inspected for kinks and breaks? ® ❑ ❑ EJ Were all items on the equipment manufacturer' s maintenance checklist completed ? ® El Q Were all LLDs confirmed 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 XIV , 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.) ® Vacuum ❑ Pressure ❑ Hydrostatic jen.sr ID Components) Monitored By This Sensor Sensor Functionality Interstitial Test Communication Test 87 Product ® Pass Fail ❑ Pass ❑ Fail 87-91 Vapor Line ® Pass ❑ Fail ❑ Pass ❑ Fail 87 Vent ® Pass ❑ Fail ❑ Pass ❑ Fail S291 Product ® Pass ❑ Fail ❑ Pass ❑ Fail S21 91 Vent ® Pass F] Fail ❑ Pass ElFail S22 DSL Product ® Pass ❑ Fail ❑ Pass Fail ❑ S23 DSL Vent ® Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail [❑ Pass ❑ Fail ❑ Pass ❑ Fail j ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail E ❑ Pass ❑ Fail ❑ Pass ❑ Fail How was interstitial communication verified ? ❑ Simulated Leak at Far Ends of the Interstitial Space ❑❑ VGaugenspection E] other (Describe the method 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