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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 ® 3 GPH ❑ 0.1 GPH ❑ 0.2 GPH Diesel ❑ ❑ Has the testing apparatus been properly calibrated? ❑ ❑ ❑ For emergency generator tank systems, does the LLD create an audible and visual ❑ ❑ ❑ alarm when a leak is detected? ❑ For mechanical LLDs, does the LLD restrict the flow through the pipe when a ❑ ❑ ❑ release is detected? Leak Detectors Not Tested ❑ ❑ For electronic LLDs, does the turbine automatically shut off when a release is ❑ ❑ ❑ detected? For electronic LLDs, does the turbine automatically shut off if any portion of the ❑ ❑ ❑ monitoring system is disabled or disconnected? ❑ ❑ For electronic LLDs, does the turbine automatically shut off if any portion of the ❑ ❑ ❑ 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? ❑ ❑ ❑ Were all LLDs confirmed operational within regulatory requirements? ❑ ❑ ❑ LLD ID LLD Model Lines Monitored Pass Fail T-1 VMI - LD2000 Diesel ❑ ❑ T-2 VMI - LD2000 87 Unleaded ❑ ❑ T-3 VMI - LD2000 91 Super Unleaded ❑ ❑ ❑ ❑ Leak Detectors Not Tested ❑ ❑ on This Certification ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 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