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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page 5 of 6) <br /> XVI. LINE LEAK DETECTOR TESTING <br /> r 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? r r r <br /> Check all that apply.) Simulated leak rate verified : 3 GPG r 1 . 1 GPG 0 . 2 GPH <br /> Was the testing apparatus properly calibrated ? r r r <br /> For emergency generator tank systems , does the LLD create an audible and visual alarm when a leak is detected ? r r r <br /> For mechanical LLDs , does the LLD restrict the flow through the pipe when a leak is detected ? r r r <br /> For electronic LLDs , does the turbine automatically shut off when a leak is detected ? r r r <br /> For electronic LLDs , does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected ? r r r <br /> For electronic LLDs , does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? r r r <br /> For electronic LLDs , have all accessible wiring connections been visually inspected for kinks and breaks? r r r <br /> Were all items on the equipment manufacturer's maintenance checklist completed ? r r r <br /> Were all LLDs confirmed operational within regulatory requirements? r r r <br /> For any answer of 'W" above, describe in section X111 how and when these issues were or will be corrected. <br /> XIII . COMMENTS <br /> XIV. VACUUM / PRESSURE/ HYDROSTATIC MONITORING EQUIPMENT TESTING <br /> r' 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 . ) r Vacuum r Pressure r Hydrostatic <br /> Sensor ID Component(s) Monitored, by this Sensor Sensor Functionality Interstitial Communication <br /> Test' Test <br /> r Pass r Fail r Pass r Fail <br /> r Pass r Fail r Pass r Fail <br /> F Pass r Fail r Pass r Fail <br /> r Pass r Fail r Pass r Fail <br /> r Pass r Fail r Pass r Fail <br /> r Pass r Fail r Pass r Fail <br /> r Pass r Fail r Pass r Fail <br /> r Pass r Fail r Pass r Fail <br /> r Pass r Fail r Pass r Fail <br /> r Pass r Fail r Pass r Fail <br /> r Pass r Fail r Pass r Fail <br /> r Pass r Fail r Pass r Fail <br /> How was interstitial communication verified? r Simulated leak at far ends of the interstitial space . r Visual Inspection <br /> r Other Describe the method in section XV below.) r Gauge <br /> Was the vacuum or pressure restored to operating levels in all interstitial spaces? r 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 /> GPH = Gallons per hour, Y = Yes , N = No , NA = Not applicable , VPH = Vacuum /Pressure/ Hydrostatic , ID = Identification <br />