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UNDERGROUND STORAGE TANK <br />MONITORING SYSTEM CERTIFICATION FORM (Page 5 of 6) <br />GPH =Gallons per hour, Y = Yes, N = No, NA Not <br />XVI. LINE LEAK DETECTOR TESTING <br />r Check this box if line leak detectors (LLD) are NOT installed. (Do not complete this section.) <br />This section must be completed if LLDs are installed. <br />Y <br />N <br />NA <br />Was a leak simulated to verify LLD performance? <br />Check all that apply.) Simulated leak rate verified: 3 GPG r 1.1 GPG r 0.2 GPH <br />Was the testing apparatus properly calibrated? <br />r <br />r <br />For emergency generator tank systems, does the LLD create an audible and visual alarm when a leak is detected? <br />r <br />r <br />I✓ <br />For mechanical LLDs, does the LLD restrict the flow through the pipe when a leak is detected? <br />r <br />r <br />W' <br />For electronic LLDs, does the turbine automatically shut off when a leak is detected? <br />Iv <br />r <br />r <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br />P <br />r <br />r <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br />r <br />r <br />For electronic LLDs, have all accessible wiring connections been visually inspected for kinks and breaks? <br />F <br />r <br />r <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />r <br />r <br />Were all LLDs confirmed operational within regulatory requirements? <br />r <br />r <br />r <br />For any answer of 'W" above, describe in section Xlll how and when these issues were or <br />will be corrected. <br />XIII. COMMENTS <br />XIV. ` VACUUM / PRESSURE/ HYDROSTATIC MONITORING EQUIPMENT TESTING <br />F 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 r Pressure r Hydrostatic <br />Sensor lD <br />Component(s) Monitored by this Sensor <br />Sensor Functionality <br />Test <br />Interstitial <br />Communication <br />Test <br />S1 <br />87 PROD, STP <br />P Pass r Fail <br />r Pass <br />r <br />Fail <br />S2 <br />87 FILL <br />I✓ Pass r Fail <br />Iv Pass <br />r <br />Fail <br />S3 <br />V.R. ALL UDC <br />r70 Pass r Fail <br />I✓ Pass <br />r <br />Fail <br />S4 <br />91 PROD. STP <br />IV' Pass r Fail <br />r Pass <br />r <br />Fail <br />S5 <br />91 VENT FILL <br />F Pass r Fail <br />r Pass <br />r <br />Fail <br />S6 <br />DSL PROD. <br />h Pass r Fail <br />I0 Pass <br />r <br />Fail <br />S7 <br />DSL FILL <br />r Pass r Fail <br />Iv Pass <br />r <br />Fail <br />r Pass r Fail <br />r Pass <br />r <br />Fail <br />r Pass r Fail <br />r Pass <br />r <br />Fail <br />r Pass r Fail <br />r Pass <br />r <br />Fail <br />r Pass r Fail <br />r Pass <br />r <br />Fail <br />r Pass r Fail <br />r Pass <br />r <br />Fail <br />How was interstitial communication verified? r Simulated leak at far ends of the interstitial space. <br />ry Other Describe the method in section XV below.) <br />r <br />Ids <br />Visual Inspection <br />Gauge <br />Was the vacuum or pressure restored to operating levels in all interstitial spaces? F Yes r No (Describe the reason <br />in section <br />XV below.) <br />For any answer of "N" above, describe in section X111 how and when these issues were or <br />will be corrected. <br />XV. COMMENTS <br />applicable, VPH =Vacuum/Pressure/Hydrostatic, ID =Identification <br />