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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM ( Page`5 of 6) <br /> XVI . '' LINE LEAK DETECTOR TESTING <br /> F Check this box if line leak detectors (LLD) are NOT installed . (Do not complete this section. ) Y N NA <br /> This section must be completed if LLDs are installed . <br /> Was a leak simulated to verify LLD performance? r I� <br /> (Check all that apply.) Simulated leak rate verified : ' 3 GPH r� 1 . 1 GPH 0 . 2 GPH <br /> Was the testing apparatus properly calibrated ? r r <br /> For emergency generator tank systems , does the LLD create an audible and visual alarm when a leak is detected? I- <br /> For mechanical LLDs , does the LLD restrict the flow through the pipe when a leak is detected ? <br /> For electronic LLDs , does the turbine automatically shut off when a leak is detected ? jir <br /> For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected ? I� I� 0 <br /> For electronic LLDs , does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? r I- r <br /> For electronic LLDs , have all accessible wiring connections been visually inspected for kinks and breaks? h rw <br /> Were all items on the equipment manufacturer's maintenance checklist completed ? W F r <br /> Were all LLDs confirmed operational within regulatory requirements? <br /> For any answer of "N " above, describe in section X111 how and when these issues were or will be corrected. <br /> XIII . COMMENTS <br /> XIV. VACUUM / PRESSURE/ HYDROSTATIC' MONITORING EQUIPMENT TESTING <br /> W' Check this box if VPH monitoring is NOT used . (Do not complete this section.) <br /> This section must be completed if VPH monitoring is used to perform leak detection monitoring . <br /> System Type (Mark all that apply . ) I' Vacuum I' Pressure F, Hydrostatic <br /> or Functionalit <br /> Sensy Interstitial Communication <br /> Sensor ID Component(s) Monitored by this Sensor ' Test Test <br /> I- Pass F Fail r' Pass I° Fail <br /> r Pass r' Fail r Pass Fail <br /> I � Pass I" Fail Pass f Fail <br /> Pass Fail I� Pass r Fail <br /> Pass r Fail r Pass I— Fail <br /> r Pass r Fail I' Pass Fail <br /> I" Pass r Fail I" Pass r Fail <br /> r Pass F Fail r' Pass Fail <br /> F Pass r Fail Pass h Fail <br /> I Pass r' Fail Pass I� Fail <br /> r' Pass r Fail I@ Pass r Fail <br /> r Pass F Fail Pass F Fail <br /> How was interstitial communication verified ? r Simulated leak at far ends of the interstitial space . r Visual Inspection <br /> Other (Describe the method in section XV below.) r Gauge <br /> Was the vacuum or pressure restored to operating levels in all interstitial spaces? Yes No (Describe the reason in section XV below.) <br /> For any answer of "N" above, describe in section X111 how and when these issues were or will be corrected. <br /> XV. COMMENTS <br /> GPH = Gallons per hour, Y = Yes , N = No , NA = Not applicable, VPH = Vacuum/Pressure/ Hydrostatic, ID = Identification <br />