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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM <br /> XII. LINE LEAK DETECTOR TESTING <br /> CtreCik fi=S box it hrie 42kOCTeCIC'S L LL-a-e MOT,nslal*a IZ)6 r>af CD t1D ere 7+.s SLK7't7^^-- <br /> TftbwtlonmLWboconokpftdNLLDs&reinstoled Y N NA <br /> Was a ksik srrnutated to v"LLD pe <br /> aQ!fiat SMnulaled leek rate vwAed ■ 3 GPH 0 T GPH 0 7 GpH ❑■ 0 ❑ <br /> ',*Ess!t+e tL+s`zirp apYa^a!kt3 praptrty can't-ate3"' �n r� ❑ <br /> For effmigW icy generatpr tank systems does the LLD Create an sudibl•and visual alarm when a leak r5 dirt wal 0 0 Q <br /> For mechanical LLQ%,does the LLD r*s'.-Ct V*ftw[trough the pipe when a'Oak*detected, Q 0 0 <br /> For ei0cfA 4 LLDs.does the turbn*iLtOm•trCaRy Shut off when a leak is defeclt ? ❑ 0 <br /> For V*CftvniC LLD& does the turtw*autdma4caay&fill oil if any porton of the mondonng system rt dr&abled or daconnacw'? ❑ ❑ EI <br /> For eiaGrork LLDs does the ke li'll automattcaay shut off if any portion of the morutonng system rnalfurnct'om or fairs a testi ❑ ❑ <br /> FW SkKlrorwc LLD& have am access:bleyorlrg connec em been wsuoy nespected for kinks arra Wellks? Q ❑ I) <br /> Were$1 4e+ns an the epu'Pm"t m2'%'?k curers asakntenance checkkst completed? Q ❑ T ❑ <br /> VNWe all LLDs confirmed operatronar",~n tegu,atcry requ rernersta" - [.] ❑ ❑ <br /> For 81Y ans+wrat 1Nabavk dese"be to seetrcn Xiff how and when tlresr+ssues were or will be corrected <br /> -- XIII. COMMENTS <br /> XIV. VACUUM I PRESSURE! HYDROSTATIC MONITORING EQUIPMENT TESTING <br /> Q Check this box aVF++rnoni:pr-ng is NOT usCd if rD'�G• C C'r .sA-. <br /> i This*WOlm rnuar be cvmpleted if VPH manfronng is ussd fo perform leak detection manrronng. <br /> v System Type IV12rh au thw apply l 0 Vacuum ❑Pressure !"y3f�5SWIC - <br /> Serrsar1Q Gcmpnr,e+st{Sy Monitored by t+ns Sensor tensor=und*nafdy �iftefsbtw Gammurw�flOn <br /> Tesl T"t <br /> ❑pass ❑Fail p lass C Fad <br /> ❑Pass Q Fail l', Pass Fad <br /> ❑Pass [ Fail Q pass !Fail <br /> ❑Piss ❑Fad 0 Paas ❑Fad <br /> ❑crass G Faa 0 Prix ❑Fa4 <br /> ❑Pass ©Fan ❑Pau I]Fad <br /> ❑Pass 0 Fail ❑Pass ©Fa't <br /> 0 Pass ❑Fail ❑Pns ❑Fa>r <br /> ❑Piss 0 Fail ❑Pass ❑Fad <br /> ❑PaSS ❑Fail 0 Pass ❑ Caw <br /> ❑PaSS ❑Fart ❑P" ❑Fall <br /> ❑Pass ❑Fail []Pas& []Fad <br /> How was interstrTal CommunpcaW veribeV Q Srmulatad leak at fat ends of[r ,{ @ %,dual lr ipaCtlpn <br /> ❑0VW(Down0•the methpa p Gauge <br /> Was 0*vacuum or pressure resuxeo tc ooeranng levels in an lntersimal spaces? Yes Q No lDraG+rbe the rea3Prr'n ssctio- • . dabw! <br /> F6r any answer of"FAk"abavrr descnba in section W how and when Mesa as sues weer or two b•cor+acaaoz � <br /> w �XV. COMMENTS <br /> GPM=Gallcam par hour.Y=Ya L N=Na,NA=[dot appUcable,VPH=VacuwrlPr�%urpkydrCetRrc,fb=klBntfita06n <br /> Ilk 'A <br /> SCANNER <br /> ODYSSEY APPS <br />