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Appendix VI <br /> 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 ❑ 0.1 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 N ❑ ❑ <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 TD LLD Model Lines Monitored Pass Fail <br /> Q1 PLLD 87 ® ❑ <br /> Q2 PLLD 91 ® ❑ <br /> Q3 PLLD DSL ® ❑ <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 a#Monitoring equipment either replaced or repaired in Section 9. <br /> Page 6 of 7 <br />