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UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM XII. LINE LEAK DETECTOR TESTING Check this box if line leak delectcrs(LLD)are NOT installed.(Do rKt complete this section.) Y N NA This seclkm must be mnriafeted If LLDs are Instaged. Was a leak simulated to verify LLD perform ance? 0 ❑ ❑ Check al that apply.) Sim u lated leak rate verified 3 G 0.1 GM 0.2 GPH Was the testing apparatus property calibrated? 0 ❑ ❑ For emergency generals lank systems,does the LLD create an audible and mand alarm when a leak is defected? ❑ ❑ 0 For mechanical LLDs,does the LLD restrict the low through the pipe when a leak is defected? ❑' ❑ ❑ For electronic LLDs,does the turbine automatically shut awhen a leak is detected? ❑ ❑ 0 For electronic LLDs,does the turbine automatically shut off ifany portion ofthe monitoring system is disabled or disconnected? ❑ ❑ 0 For electronic LLDa,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a lest? ❑ ❑ 0 For electremic LLDa,have all accessible wiring connections been visually inspected for kinks and breaks? ❑ ❑ 0 Ware al items on the equipment manufacturers maintenance checklist completed? 0 ❑ ❑ Were al LLDs confirmed operational within regulatory requirements? 0 ❑ ❑ Forany answer&"N'above descdbe In sscslon XNl howancl when these Issues ware or wlN be ro rscled. XIII. COMMENTS The LD 200D on the T?:UNLD lank failed!and was replaced Ike for tike with a new LD 200D.Tested and passed. 0LDSenalnumberis07031410. NEWSemdlnumberis18101809. XIV. VACUUM /PRESSURE/HYDROSTATIC MONITORING EQUIPMENT TESTING El Check this box k VPH monitoring is NOT used. (Do rut conpkte th8 section.) This sectlon rmrst he rorrykiedXVPN monlbrhg Is usedto perform leak detection monitairg. System Type(Mark Al that apply.) ❑Vacuum ❑Pressure ❑Hydrostatic Sensor Functionality Interstitial Communication Sensor ID Co mponenl(s)Monitored by this Sensor Test Test ❑Pass ❑Fall ❑Pass ❑Fall ❑Pass ❑Fall ❑Pass ❑Fall ❑Pass ❑Fall ❑Pass ❑Fall ❑Pass ❑Fall ❑Pass ❑Fall ❑Pass ❑Fall ❑Pass ❑Fall ❑Pass ❑Fall ❑Pass ❑Fall ❑Pass ❑Fall ❑Pass ❑Fall ❑Pass ❑Fall ❑Pass ❑Fall ❑Pass ❑Fall ❑Pass ❑Fall ❑Pass ❑Fail El Pass [I Fall ❑Pass ❑Fail ❑Pass ❑Fall ❑Pass ❑Fail ❑Pass ❑Fall How was interstitial communication veified? ❑Simulated leak at far ends ofthe interstitial space. ❑Visual Inspection Other(Describe the method h section XV beb .) ❑Gauge Was the vacuum or pressure restored to cperaltng levels in Al interstitial spaces? 0 Yes ❑No(Describe the reason n section XV beb ) Jacs,any answerof^FAIL'ah clescWhe In secflon XVhow and when these Issues wares will he comecterl. XV. COMMENTS GRH=Gallons per herr,Y=Yes,N=No,NA=Not q3plkable,VPH=VaaarrvPrassrerllydrmldic,ID=lobnfificetin