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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 rate verified : ( Check all that apply) <br /> ® 3 GPH [:10 . 1 GPH El0 . 2GPH Yes No NA <br /> Has the testing apparatus been properly calibrated ? ® ❑ ❑ <br /> For emergency generator tank systems , does the LLD create an audible and visual ❑ ❑ <br /> alarm when a leak is detected ? <br /> For mechanical LLDs , does the LLD restrict the flow through the pipe when a ❑ ❑ <br /> release is detected ? <br /> For electronic LLDs , does the turbine automatically shut off when a leak is ® ❑ ❑ <br /> detected ? <br /> For electronic LLDs , does the turbine automatically shut off if any portion of the ® ❑ ❑ <br /> monitoring system is disabled or disconnected ? <br /> For electronic LLDs , does the turbine automatically shut off if any portion of the ® ❑ ❑ <br /> monitoring system malfunctions or fails a tightness test? <br /> For electronic LLDs , have all accessible wiring connections been visually inspected ® ❑ ❑ <br /> for kinks and breaks ? <br /> Were all items on the equipment manufacturer' s maintenance checklist ® ❑ ❑ <br /> completed ? <br /> Were all LLDs confirmed operational within regulatory requirements ? ® ❑ ❑ <br /> LLD ID LLD Model Lines Monitored Pass Fail <br /> Q1 PLLD DSL ® ❑ <br /> Q2 PLLD 91 ® ❑ <br /> Q3 PLLD 87 ® ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <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 6 of 9 <br />