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Underground Storage Tani, <br /> Monitoring System Certification Form <br /> 7 LINE LEAK DETECTOR TEST114G <br /> C Check this box if line leak detectors ARE NOT installed. (Do not complete this section.) <br /> Simulated release rate verified: (Check all that apply.) Yes No NA <br /> M 3 GPH © 01 GPH E) 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 © ED <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 automa 'tally shut o if any portion of the <br /> Monitoring system is disabled or disconnected. <br /> For electronic LLDs, does the turbine automatic shu aft if any portion of the <br /> - <br /> Formonitoring system malfunctions or fails a ti htnes to <br /> For electronic LLDs, have all accessible wiring cone ctions been visually inspected <br /> for kinks and breaks? <br /> Were all items on the equipment manufacturer's ainte nce checklist completed? ® 8 <br /> Were all LLDs confirmed operational within regulatory requirements? <br /> LLD 1D LLD Model Lines Monitored Pass Fail <br /> 0 <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 />