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I <br />UNDERGROUND STORAGE TANK <br />MONITORING SYSTEM CERTIFICATION FORM (Page 5 of 6) <br />XII. LINE LEAK DETECTOR TESTING <br />LI Check this box if line leak detectors (LLD) are NOT installed. (Do not complete this section.) <br />This section must be completed if LLDs are installed. Y N NA <br />Was a leak simulated to verify LLD performance? <br />(Check Other apply) Simulated leak rate verified: LI 3 GPH LI 0.1 GPH LII 0.2 GPH <br />Was the testing apparatus properly calibrated? <br />For emergency generator tank systems, does the LLD create an audible and visual alarm when a leak is detected? <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? <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or falls a test? <br />For electronic LLDs, have all accessible wiring connections been visually inspected for kinks and breaks? <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />Were all LLDs confirmed operational within regulatory requirements? <br />For any answer of "N" above, describe in Section XIII how and when these issues were or will be corrected. <br />XIII. COMMENTS <br />Leak Detectors installed and will be tested at a later date. <br />XIV. VACUUM / PRESSURE / HYDROSTATIC MONITORING EQUIPMENT TESTING <br />This <br />X Check this box if VPH monitoring is NOT used. (Do not complete this section.) <br />section must be completed if VPH monitoring is used to perform leak detection monitoring. <br />System Type (Mark all that apply.) LI Vacuum LI Pressure II Hydrostatic <br />Sensor ID Component(S) Monitored By This Sensor Sensor Functionality <br />Test <br />Interstitial Communication <br />Test <br />Pass Fail LI Pass LI Fail <br />LI Pass LI Fail LI Pass LI Fall <br />Pass LI Fail Pass Li Fall <br />LI Pass Li Fail LI Pass Fail <br />LI Pass LI Fall LI Pass in Fail <br />LI Pass LI Fail LI Pass LI Fall <br />LI Pass LI Fail LI Pass LI Fail <br />LI Pass LI Fail LI Pass LI Fail <br />. Pass LI Fail LI Pass LI Fail <br />. Pass LI Fail LI Pass Fall <br />Pass LI Fall LI Pass Fail <br />LI Pass LI Fall LI Pass 111 Fail <br />How was interstitial communication verified? LI Simulated Leak at Far Ends of the Interstitial Space LI Visua inspection <br />D Other (Describe the method in section XV below.) LI Gauge <br />Was the vacuum or pressure restored to operating levels in all interstitial spaces? LI Yes LI No (Describe the reason in section XV below.) <br />For any answer of "Fall" above, describe in Section XV 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/Hydrostalic, ID = identification