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TYPEOFgCT/py /Pr�'t�co�jfi�i���i- ,9.� <br /> - <br /> Underground Storage Tank <br /> Monitoring I;ystem Certification Form <br /> /NE LEAK DETECTOR TESTING <br /> check this box if line leak detectors— <br /> ARE NOT installed. (Do not com let <br /> �r,ulated release rate verified: (Check all <br /> l that a P e this section.) <br /> 5 03 GPH ❑ 0.1 GPH ❑ 0.2 GPH pplY-) <br /> Nas the testing apparatus been properly calibrated? Yes No NA <br /> emergency generator tanks ® ❑ ❑ <br /> For 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 an ❑ ❑ <br /> c monitorin system is disabled or disconnected? y portion of the ❑ ❑ <br /> �c i=or electronic LLDs, does the turbine autoratically shut off if an <br /> G.p moni oring system malfunctions or fails a tiq htness test? Y portion of the <br /> For electronic LLDs, have all accessi ble wiringY inspected <br /> connections been visual) in ❑ ❑ <br /> for kinks and breaks? <br /> Were all items on the equipment manufacturer's maintenance checklist completed? ❑ ❑ <br /> � �y Were all LLDs confirmed operational within regulatory requirements? <br /> fi -� ® ❑ <br /> s� ak�e LLD ID LLD Model ❑ <br /> d� MECHANICAL Lines Monitored <br /> g� Pass Fail <br /> ss� 6�� MECHANICAL 91 ® ❑ <br /> P` a MECHANICAL DSL <br /> MECHANICAL E85 ❑ <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 4 of 6 <br /> � X <br />