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Underground Storage Tank <br /> Monitoring System Certification Form <br /> 7. LINE LEAK DETECTOR TESTING <br /> ❑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; No '.: A,j <br /> x3 GPH 00.1 GPH❑0.2 GPH <br /> Has the testing apparatus been properly calibrated? x ❑ ❑ <br /> For emergency generator tank systems, does the LLD create an audible and visual alarm ❑ ❑ x <br /> when a leak is detected? <br /> For mechanical LLDs, does the LLD restrict the flow through the pipe when a release is x ❑ ❑ <br /> detected? <br /> For electronic LLDs, does the turbine automatically shut off when a release is detected? x ❑ <br /> For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring x ❑ <br /> system is disabled or disconnected? <br /> For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring x ❑ <br /> system malfunctions or fails a tightness test? <br /> For electronic LLDs, have all accessible wiring connections been visually inspected for x ❑ <br /> kinks and breaks? <br /> Were all items on the equipment manufacturer's maintenance checklist completed? X ❑ ❑ <br /> Were all LLDs confirmed operational within regulatory requirements? x ❑ <br /> LLD ID LLD Model Lines Monitored Pass Fail <br /> Q1 V/R 8484 87 x ❑ <br /> Q2 V/R 8484 91 x ❑ <br /> T3 VM199LD2000 Diesel x ❑ <br /> D ❑ <br /> ❑ ❑ <br /> D ❑ <br /> D ❑ <br /> D ❑ <br /> ❑ ❑ <br /> Describe all answers marked "No"or"Fail"and proposed remedy in Section 9. <br /> List all monitoring equipment either replaced or repaired in Section 9 <br /> Page 4of6 <br />