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Underground Storage Tank <br /> Monitoring System Certification Form <br /> 7. 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 I <br /> ✓! 3 GPH LJ 0.1 GPH Ll 0.2 GPH <br /> Has the testing apparatus been properly calibrated? a 0 D <br /> For emergency generator tank systems, does the LLD create an audible and visual Lj LA 0 <br /> alarm when a leak is detected? <br /> For mechanical LLDs, does the LLD restrict the flow through the pipe when a ® Ll L1 <br /> release is detected? <br /> For electronic LLDs, does the turbine automatically shut off when a release is Ll Li 121 <br /> detected? <br /> For electronic LLDs, does the turbine automatically shut off if any portion of the El <br /> monitoring system is disabled or disconnected? <br /> For electronic LLDs, does the turbine automatically shut off if any portion of the Ll 0 <br /> 91 <br /> monitorinq system maifunctioIns or fails a tightness test? <br /> For electronic LLDs, have all accessible wiring connections been Visually inspected Ll Lj A <br /> for kinks and breaks? <br /> Were all items on the equipment manufacturer's maintenance checklist completed? ® 0 ll <br /> Were all LLDs confirmed operational within regulatory requirements? 0 L11 Lj <br /> LLD ID LLD Model Liras Monitored Pass Fail <br /> T1 Red Jacket FX1V REG. PROD. LINE 0 12 <br /> T2 Vaporless LD-2000 PREM. PROD. LINE V) Q <br /> T3 Vaporless LD-2000 DSL PROD. LINE <br /> Lj L_f <br /> Q LI <br /> ® Ll <br /> Ll 11 <br /> L] Lj <br /> D Ll <br /> Lj Li <br /> Ej Lj <br /> Q Q <br /> Describe all answers marked "No"or `Fail"and proposed remedy it Section 9. <br /> List all monitoring equipment either replaced or repairer!in Section 9 <br /> Page 4 of 6 <br />