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Underground Storage Tank <br /> Monitoring System Certification Form <br /> 1. LINE LEAK DETECTOR TESTING <br /> LJ Check this box if line leak detectors ARE NOT installed. (Do not complete this section.) <br /> Simulated release rate verified: (Check all that apply.) Yes Na I <br /> ® 3 GPH LJ 0.1 GPH Ll 0.2 GPH <br /> Has the testing apparatus been properly calibrated? <br /> For emergency generator tank systems, does the LLD create an audible and visual <br /> alarm when a leak is detected? <br /> For mechanical LLDs, does the LLD restrict the flaw through the pipe when a D D <br /> release is detected? <br /> For electronic LLDs, does the turbine automatically shut off when a release is ® Ll El <br /> detected? <br /> For electronic LLDs, does the turbine automatically shut off if any portion of the R) D D <br /> monitoring system is disabled or disconnected? <br /> For electronic LLDs, does the turbine automatically shut off if any portion of the ® lLl <br /> monitoring system malfunctions Dr fails a tightness test? <br /> For electronic LLDs, have all accessible wiring connections been visually inspected RI IEj El <br /> for kinks and breaks? <br /> Were all items on the equipment manufacturer's maintenance checklist completed? RI Ll El <br /> Were all LLDs confirmed operational within regulatory requirements? R1 D D <br /> LLD ID LLD Madel Limes Monitored ,Pass Fail <br /> Q1 848480-001 REG.PROD.LINE ® 0 <br /> Qz 848480-001 MID GRADE PROD.LINE ® 11 <br /> Q3 848480-001 SUP.PROD.LINE ® 0 <br /> Ll Ll <br /> Ll Ij <br /> Il Ij <br /> Ll Ll <br /> L1 Li <br /> Ll Ll <br /> 11 D <br /> El I1 <br /> Il Il <br /> Describe all answers marked "No"or"Fail'and proposed remedy it Section 9. <br /> List all monitoring equipment either replaced or repaired in Section 9 <br /> Page 4 of 6 <br />