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rt <br /> k f, e <br /> 41 1 47 <br /> LEM <br /> rr� rnNo ar i�r <br /> UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM tPativ h of it) <br /> XII. LINE LEAK DETECTOR 'TESTING <br /> FOChacik N tine teak detectors (L! D) are NOT Installed. (Do not complete this sedlon j Y N NA <br /> ust be com tared_ � IFt.LDs era instaltad. <br /> Was a leak stmutated to Verity LLD perfom mm? <br /> (Check all that apph.j Slmufeted leak tate vedfled: 3 GPM 0.1 GPH C] 0.2 GPH <br /> Was the tear apparatus p calibrated? <br /> For emergM generator tank systems, does the LLD create an audile end visual afarm when a lock Is detected? <br /> For mechanical LLDs, does the LLD restdd the now Ihrmvh the plp# when a teak Is detected? <br /> For eketm* LLDs, dons the turbine automa shut orf when a leak is detected? <br /> For electronte 1.1.0s, does Ube turbine automatically shut off if any portion of the manito8ng system is disabled or dlsconneded? <br /> For etedronle LLbs, does the twbine autarrratkally Abid off itowf2ttion of the moattatt system maifnndons or tans a test? <br /> For dedtonic l LDs, have an accessible w tog connections been vis uany Ins ed for kinks and breaks? [DEER gill <br /> Were aU Items on the equipment manufacturer's maintenance checklist completed? <br /> Were an LLDs car►Mrred anal wNhtn regulatory resents? 010100 <br /> For any answer of "N" above, describe In Section )(111 how and when these Issues were or will be corrected <br /> Xltl. COMMENTS - <br /> XIV. VACUUM I PRESSURE 1 HYDROSTATIC MONITORING EQUIPMENT TESTING <br /> Chock this box it VPH monnadng Is NOT used. (Do not complete Ws sadkwL) <br /> 4 This section must be completed if VPH moniforing is used to perform leak detection monitol . <br /> System Type (Mark all that apply.) ❑ Vagrum ❑ Pressure C1 Hydrostatic <br /> S �orFuncilonality niarstiliai Communicallon <br /> Sensor ID Component(S) Monitored By This Sensor <br /> Test Test <br /> Paas Fall 017ass - Fan <br /> Pass Fal Pass FOR <br /> - Paas Fall Pass Fan <br /> Pass Feil Pass FON <br /> — -.— <br /> Pass Fan Pass Fall <br /> Pass Fail Pass Fan _ <br /> Pass Fail Pass Fan <br /> Pass Fall Pass Fan <br /> Page Fell Pass Fan <br /> Pass Fan Pass Fag <br /> - Pass_ Fag Pass Fall <br /> - Pass Fail Pass Fan <br /> Howwas InterstiU corrKmrnicallon ve 7 ShuNated Leak at Far Ends of the bderstinal Space Vlsuai Inspection <br /> Otheregalbafhemethodinsedlon "bebw.) Ga e <br /> Was the Vam= or pressors restored spaces? Yes Na Desedbe the reason N sedbn XV balow•) <br /> Far any answer of "FaJt" above, desedbe in Section XV how and when these Issues wars or will be con octad <br /> XV. COMMENTS <br /> MuGeti mPerHW, Y = Yea, N =No, NA= No1AppkdA% VPHu IDakleaication <br />