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Underground Storage Tank <br /> Monitoring System Certification Form <br /> F. 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 No NA <br /> 0 3 GPH LJ 4.1 GPH Ll 0.2 GPH <br /> Has the testing apparatus been properly calibrated? a El Lj <br /> For emergency generator tank systems, does the LLD create an audible and visual L] A A <br /> alarm when a leak is detected? <br /> For mechanical LLDs, does the LLD restrict the flaw through the pipe when a Ll Ll <br /> release is detected? <br /> For electronic LLDs, does the turbine automatically shut off when a release is 0 Ll Li <br /> detected? <br /> For electronic LLDs, does the turbine automatically shut off if any portion of the 0 Ll Ll <br /> monitoring system is disabled or disconnected? <br /> For electronic LLDs, does the turbine automatically shut off if any portion of the ® Ll El <br /> mon itorirg system malfunctions or fails a tiq htness test? <br /> For electronic LLDs, have all accessible wiring connections been visually inspected ® Li Li <br /> for kinks and breaks? <br /> Were all items on the equipment manufacturer's maintenance checklist completed? ® Ll L1 <br /> Were all LLDs confirmed operational within regulatory requirements? 0 Lj Ll <br /> LLD ID LLD Model Lines Monitored Pass Fart <br /> Q1 848480-001 91 0 11 <br /> Q2 848480-001 87 0 Ll <br /> Il L <br /> El El <br /> 71 I71 <br /> iJ L <br /> L) L] <br /> 1j 1j <br /> El Ll <br /> El Ii <br /> L1 Q <br /> Describe all answers marked `"No"or"Fail"and proposed remedy in Secaion 9. <br /> List all monitoring equipment either replaced or repaired in Section 9 <br /> Page 4 of 6 <br />