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<br />Underground Storage Tank <br />Monitoring System Certification Form <br /> <br /> <br />Page 4 of 6 <br />7. LINE LEAK DETECTOR TESTING <br /> <br />☐☐☐☐ Check this box if line leak detectors ARE NOT installed. (Do not complete this section.) <br /> <br />Simulated release rate verified: (Check all that apply.) <br /> ☒☒☒☒ 3 GPH ☐☐☐☐ 0.1 GPH ☐☐☐☐ 0.2 GPH 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 release is <br />detected? ☐☐☐☐ ☐☐☐☐ ☒☒☒☒ <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring <br />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 completed? ☒☒☒☒ ☐☐☐☐ ☐☐☐☐ <br />Were all LLDs confirmed operational within regulatory requirements? ☒☒☒☒ ☐☐☐☐ ☐☐☐☐ <br /> <br />LLD ID LLD Model Lines Monitored Pass Fail <br />#1-Reg VR FX1V Regular ☒☒☒☒ ☐☐☐☐ <br />#2-Prem VMI LD2000 Premium ☒☒☒☒ ☐☐☐☐ <br />#3-Dies VMI LD2000 Diesel ☒☒☒☒ ☐☐☐☐ <br /> ☐☐☐☐ ☐☐☐☐ <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