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Underground Storage Tank <br /> Monitoring System Certification Form <br /> T. LINE LEAK DETECTOR TESTING----- <br /> 1C heck this box if Iine leak detectors A RE NOT installed'. (Do not cornpiete this section.) <br /> Simulated release rate verified; (Check all that apply.) Yes No NA <br /> PH rj 0,1 GPH 0-2 GPH <br /> Has the testing apparatus been properly caIibfate d? 0 <br /> For emergency generator tank systems, does the LLD create an audible and visual � � � <br /> alarrn when a leak is detected'? <br /> For mechanical LLps. does the LLD restrict the flow through the pipe when a <br /> release is detected? <br /> For electronic LL Ds, does the turbine automatically shut off when a release is <br /> detected? <br /> For electronic LLDs. does the turbine automatically shat off if any portion of the <br /> monitorings stern is disabled or disconnected? <br /> For electronic LLDs. does the turbine automaticatlyr shut off if anyr portion of the <br /> rn a n itorIng sy stem malfunctions or ifails a tightness test'? _ <br /> For electronic LL Ds, have a I C accessible wiring connections been visually inspected E] M r] <br /> for kinks and breaks? <br /> Were all items on the equipment manufacturers maintenance checklist completed? ® El <br /> Were all LLDs confirmed operational within regulatory requirements? ® ® f <br /> LZD ID LLD Model Lines Monitored Pass Fail <br /> 0'i PLLD U <br /> 02 PLLD 91 Id <br /> Q3 PLLD DSL I <br /> Q4 -PL LD E85 <br /> � fel <br /> ri <br /> Describe all answers marked "No" or"Fart"and proposed remedy in Section 9 <br /> List all inonitoring equipment either replaced or repaired in Section 9 <br /> Page 4 of 6 <br />