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Underground Storage Tank <br /> Monitoring System Certification Form <br /> T. LINE LEAK DETECTOR Tr= TIN _ <br /> FM 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 /> Has the testing apparatus been properly calibrated? ® ❑ ❑ <br /> For emergency generator tarok 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 a turbine automatically shut off when a release is <br /> detected? <br /> For electronic LLDs, does the t bine automaticaJly shut off it Y portion of the 0 ❑ + ❑ <br /> monitorin system is disabled or sconnected? I <br /> For electronic LLDs, roes the turbin automatically s off I any portion of the ❑ ❑ � <br /> monitoringstem malfunctions or fat a ti htne st? <br /> r=or electronic LLDs, have all accessib[e iring nneetions been visually inspected ❑ ❑ <br /> for kinks and breaks? _ <br /> Were all sterns on the equipment mane urdr s maintenance checklist completed? � ❑ 0 <br /> Were all LLDs confirmed operation ,, vithin regal requirements? �—En ❑ ❑ <br /> LLD 1D LLD Model dines Monitored Pass Fail <br /> ❑ ❑ <br /> ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ <br /> Describe all answers marked Wo"or"Faflu and{proposed remedy in Section 9. <br /> List all monitoring equipment either replaced or repaired in Section 9 <br /> Page 4 of 6 <br />