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Underground Storage Tank <br /> Monitoring System Certification Form <br /> 7. LANE LEAK DETECTOR TESTING <br /> Check this box if line teak detectors ARE NOT installed. (Do riot complete this section_) <br /> Simulated rebase rate verified. (Check all that apply.) Yes No NA <br /> GPI 11 0A GPH ❑ 0.2 GPH <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 Lt_Ds, does the turbine automatically shut off when a release is ❑ ❑ <br /> detected? <br /> For etectronic LLDs, does the turbine automatically shut off if any portion of the ❑ ❑ ❑ <br /> monitoring system is disabled or disconnected? <br /> For electronic LLD&, does the turbine automatically shut off if any portion of the � ❑ ❑ <br /> monitorin g system malfunctions or fails a tig htness test's <br /> For electronic LLDs, have all accessible wiring connections been visually inspected ❑ ❑ <br /> for kinks and breaks? <br /> Were all iterns on the equipment manufacturers maintenance checkIist completed? <br /> FWe re all LLDs confirmed operational within regulatory requirements? J. <br /> ❑ ❑ ❑ <br /> LLD ID LLD Model Lines Monitored Pass Fail <br /> Q 1 PLLD 87 ❑ <br /> Q 2 PLLD1 <br /> ( PLLD DSL ® ❑ <br /> Q 4 PLLD E .85 ❑ ❑ <br /> ❑ n <br /> ❑ <br /> ❑ 0 <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ 0 <br /> Describe all answers marked "No"or "Fail" and proposed remedy in Section 9 <br /> List al!mon itoring equipment either replaced or repaired io Section 9 <br /> Page 4 of 6 <br />