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Underground Storage Tank Monitoring System Certification Form 7. LINE LEAK DETECTOR TESTING ❑ Check this box if line leak detectors ARE NOT installed. (Do not complete this section.) Simulated release rate verified: (Check all that apply.) Yes No NA N 3 GPH ❑ 0.1 GPH ❑ 0.2 GPH T1 91 Product Line SN#1801112 ® ❑ Has the testing apparatus been properly calibrated? N ❑ ❑ For emergency generator tank systems, does the LLD create an audible and visual ❑ ❑ N alarm when a leak is detected? ❑ T-4 Diesel VMI LD2000 For mechanical LLDs, does the LLD restrict the flow through the pipe when a ® ❑ ❑ release is detected? ❑ ❑ For electronic LLDs, does the turbine automatically shut off when a release is ❑ ❑ N detected? For electronic LLDs, does the turbine automatically shut off if any portion of the ❑ ❑ N monitoring system is disabled or disconnected? ❑ ❑ For electronic LLDs, does the turbine automatically shut off if any portion of the ❑ ❑ N monitoring system malfunctions or fails a tightness test? ❑ For electronic LLDs, have all accessible wiring connections been visually inspected ❑ ❑ for kinks and breaks? ❑ Were all items on the equipment manufacturer's maintenance checklist completed? N ❑ ❑ Were all LLDs confirmed operational within regulatory requirements? N ❑ I ❑ LLD ID LLD Model Lines Monitored Pass Fail T-1 91 VMI LD2000 T1 91 Product Line SN#1801112 ® ❑ T-2 89 VMI LD2000 T2 89 Product Line SN#09041087 N ❑ T-3 87 VMI LD2000 T3 87 Product Line SN#20111122 N ❑ T-4 Diesel VMI LD2000 T4 Diesel Product Line SN#20011179 N ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Describe all answers marked "No" or "Fail" and proposed remedy in Section 9. List all monitoring equipment either replaced or repaired in Section 9 Page 4 of 6