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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page 5 of 6) <br /> XVI. LINE LEAK DETECTOR TESTING <br /> r Check this box if line leak detectors (LLD) are NOT installed . (Do not complete this sectioldetected ?[r <br /> N NA <br /> This section must be completed if LLDs are installed . <br /> Was a leak simulated to verify LLD performance? r <br /> (Check all that appl .) Simulated leak rate verified : r' 3 GPH 1 . 1 GPH r 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 r r <br /> For mechanical LLDs , does the LLD restrict the flow through the pipe when a leak is detected? r rFor electronic LLDs , does the turbine automatically shut off when a leak is detected ?For electronic LLDs , does the turbine automatically shut off if any portion of the monitoring system is disabled or disr r <br /> For electronic LLDs , does the turbine automatically shut off if any portion of the monitoring system malfunctions or fr r <br /> For electronic LLDs , have all accessible wiring connections been visually inspected for kinks and breaks? r r r <br /> Were all items on the equipment manufacturer' s maintenance checklist completed ? <br /> Were all LLDs confirmed operational within regulatory requirements? r' r r <br /> For any answer of 'N" above, describe in section Xlll how and when these issues were or will be corrected. <br /> XIII . COMMENTS <br /> XIV. VACUUM / PRESSURE/ HYDROSTATIC MONITORING EQUIPMENT TESTING <br /> F 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 .) FV : Vacuum r Pressure r Hydrostatic <br /> Sensor Functionality Interstitial Communication <br /> Sensor ID Component(s) Monitored ; by this Sensor ' Test ' Test <br /> S1 87 PROD . LINE r Pass r Fail r Pass r Fail <br /> S2 91 PROD . LINE r Pass r Fail r Pass r Fail <br /> S3 DSL PROD . LINE r Pass r Fail r' Pass r Fail <br /> S4 87 STP SUMP r Pass r Fail r Pass r Fail <br /> S5 87 FILL SUMP r Pass r Fail r Pass r Fail <br /> S6 91 STP SUMP r' Pass r Fail r' Pass r Fail <br /> E S7 91 FILL SUMP r' Pass r Fail r Pass r Fail <br /> S17 DSL STP SUMP r' Pass r Fail Iry Pass r Fail <br /> S18 DSL FILL SUMP rPass r Fail Pass r Fail <br /> S19 ALL VENTS r Pass r Fail Pass r Fail <br /> S20 V. R . ALL UDC'S r Pass r Fail r Pass r Fail <br /> r Pass r Fail r Pass r Fail <br /> r Simulated leak at far ends of the interstitial space . r Visual Inspection <br /> How was interstitial communication verified? <br /> r Other Describe the method in section XV below . r Gauge <br /> Was the vacuum or pressure restored to operating levels in all interstitial spaces? r Yes r No (Describe the reason in section XV below.) <br /> For any answer of 'W " above, describe in section XIII 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 />