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UNDERGROUND '.STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM ( Page 5 of 6) <br /> XVI. LINE LEAK DETECTOR TESTING <br /> Check this box if line leak detectors (LLD) are NOT installed . (Do not complete this section.) Y N NA <br /> This section must be completed if LLDs are installed . <br /> Was a leak simulated to verify LLD performance? I— <br /> (Check all that apply.) Simulated leak rate verified : ry' 3 GPH r 1 . 1 GPH r 0 . 2 GPH <br /> Was the testing apparatus properly calibrated ? Iv r r <br /> For emergency generator tank systems , does the LLD create an audible and visual alarm when a leak is detected ? r r I✓ <br /> For mechanical LLDs , does the LLD restrict the flow through the pipe when a leak is detected ? Iv r r <br /> For electronic LLDs , does the turbine automatically shut off when a leak is detected ? <br /> For electronic LLDs , does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected ? r r Iv <br /> For electronic LLDs , does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? <br /> For electronic LLDs , have all accessible wiring connections been visually inspected for kinks and breaks? I+� <br /> Were all items on the equipment manufacturer' s maintenance checklist completed ? <br /> Were all LLDs confirmed operational within regulatory requirements? r r <br /> For any answer of "N" above, describe in section X111 how and when these issues were or will be corrected. <br /> X111 . COMMENTS 7 77 77 777 <br /> � VU <br /> AL HELC <br /> XIV VACUUM PRESSURE/ HYDROSTATIC MONITORING ' E I ENS T TMG ;' ?: <br /> 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 . ) 170 Vacuum I i»i Pressure r H drostatic <br /> Sensor ID Component(s) Monitored, by this Sensor '- Sensor Functionality Interstitial Communication <br /> Test Test <br /> S1 87 PROD . Pass I' Fail I✓ Pass h Fail <br /> S2 87 STP/FILL I✓ Pass r Fail W Pass Fail <br /> S3 VAPOR/ ALL UDC'S Iw Pass I' Fail I✓ Pass Fail <br /> S4 ALL VENTS W Pass F Fail Ivo Pass r Fail <br /> S5 91 PROD . I✓ Pass r Fail IJ Pass r Fail <br /> S6 91 FILL/STP Iv Pass r Fail IV Pass r Fail <br /> r Pass Im Fail r Pass r Fail <br /> r Pass r Fail Ir" Pass r Fail <br /> I' Pass r" Fail I" Pass r Fail <br /> r Pass r Fail I" Pass r Fail <br /> I' Pass r Fail I" Pass I� Fail <br /> h Pass h Fail I" Pass Fail <br /> How was interstitial communication verified ? r Simulated leak at far ends of the interstitial space . Visual Inspection <br /> r Other (Describe the method in section XV below .) ( Gauge <br /> Was the vacuum or pressure restored to operating levels in all interstitial spaces? I/ Yes r No (Describe the reason in section XV below.) <br /> For any answer of "N " above, describe in section X111 how and when these issues were or will be corrected. <br /> XV. COMMENTS <br /> I <br /> GPH = Gallons per hour, Y = Yes , N = No , NA = Not applicable , VPH = Vacuum /Pressure/Hydrostatic, ID = Identification <br /> I <br /> i <br />