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UNDERGROUND STORAGE TANK <br />I MONITORING SYSTEM CERTIFICATION FORM (Page 5 of 6) <br />XII. LINE LEAK DETECTOR TESTING <br />Lii 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. <br />Y N NA <br />Was a leak simulated to verify LLD performance? <br />(Check all that apply.) Simulated leak rate verified: El 3 GPH El 0.1 GPH El 0.2 GPH El <br />Was the testing apparatus properly calibrated? El El El <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? El El El <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 fails 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.) El Vacuum El Pressure El Hydrostatic <br />Sensor ID Component(S) Monitored By This Sensor Sensor Functionality <br />Test <br />Interstitial Communication <br />Test <br />El Pass El Fail 0 Pass El Fail <br />El Pass El Fail El Pass EJ Fail <br />El Pass El Fail El Pass El Fail <br />El Pass El Fail El Pass El Fail <br />El Pass El Fail El Pass El Fail <br />El Pass El Fail El Pass El Fail <br />El Pass El Fail El Pass El Fail <br />El Pass El Fail El Pass El Fail <br />El Pass El Fail El Pass El Fail <br />El Pass El Fail 0 Pass El Fail <br />El Pass El Fail El Pass El Fail <br />El Pass El Fail El Pass El Fail <br />How was interstitial communication verified? El Simulated Leak at Far Ends of the Interstitial Space El <br />El Other (Describe the method in section XV below.) El <br />Visual Inspection <br />Gauge <br />Was the vacuum or pressure restored to operating levels in all interstitial spaces? El Yes El No (Describe the reason in section XV below.) <br />For any answer of "Fail" 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/Hydrostatic, ID = Identification