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Underground Storage Tank <br />Monitoring System Certification Form <br />7. LINrz LEAK OETE TOR TESTING <br />Dheck this box if Iine leak detectors ARE N. OT installed. (Do not complete this secfton. ) <br />Simulated release rate verified: (Check all that apply.) <br />3 GPH 0 0.1 GPH El 0.2 GPH <br />Yes <br />No <br />N <br />Hes the testing app atus been properly calibrated? <br />For emergency gene or tank systems, does the LLD cre4t6 an audible ar}d visual <br />afarrn when a leak is de cted? <br />For mechanical LLDs, does the LLD restrict the flow through the pipe when a <br />release is detected? :r <br />For electronic LLDs. does the Iqrbine automatically shut off when a release is <br />detected? <br />For electronic LL€)s, does the turbo a automatically shut off if any portion of the <br />monitoring system is disabled or dis nnected?- <br />For electronic LLD s, does the turbine a4toma�(�aIly sh u off if any portion of the <br />rrwanito�stem malfunctions or failsi F{tness test? <br />For electronic LLDs. Crave all accessible wi ng connections been visually inspected <br />for kinks and breaks? <br />Were all items on the equipment manuf ctl,rermaintenance checklist completed? <br />Were all LLDs confirmed operational ithin regular ry requirements? <br />LLD ID <br />LLD Model <br />Ines Monitored <br />Pass <br />Fall <br />a <br />0 <br />d <br />� <br />El <br />0 <br />Describe all answers marked Wo" or "Fair and proposed remedy in Section 9. <br />List all monitoring equipment either replaced or repaired in Section <br />Page 4 of <br />