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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page 5 of 6) <br /> XVI. LINE LEAK DETECTOR TESTING <br /> 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? _ _ � IF- F_ <br /> (Check all that apply.) Simulated leak rate verified: W 3 GPH ! ' 1.1 GPH ! ' 0.2 GPH <br /> Was the testing apparatus properly calibrated? FV_ F F <br /> For emergency generator tank systems, does the LLD create an audible and visual alarm when a leak is detected? F_ r- rv- <br /> For mechanical LLDs, does the LLD restrict the flow through the pipe when a leak is detected? F_ � ry <br /> For electronic LLDs, does the turbine automatically shut off when a leak is detected? F,/- F F <br /> For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? F%_0 F F <br /> For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? W F F <br /> For electronic LLDs, have all accessible wiring connections been visually inspected for kinks and breaks? r r- F <br /> Were all items on the equipment manufacturer's maintenance checklist completed? Fv- F_ F <br /> Were all LLDs confirmed operational within regulatory requirements? F,7 F_ F <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 Pressure Hydrostatic <br /> Sensor ID Component(s) Monitored by this Sensor Sensor Functionality Interstitial Communication <br /> Test Test <br /> S1 DSL PROD. Fv_0 Pass Fail FV_Pass F_Fail <br /> S2 DSL 2 PROD. FY-1 Pass F Fail rv-Pass r-Fail <br /> S3 VENT Fv-Pass F Fail r,-/ Pass r-Fail <br /> F_Pass I!Fail F_Pass F_Fail <br /> F_Pass Fail F_Pass F_Fail <br /> F Pass F Fail F_Pass F_Fail <br /> I—Pass F Fail r-Pass r-Fail <br /> F_Pass F Fail r-Pass r-Fail <br /> F_Pass I!Fail F_Pass F_Fail <br /> F_Pass Fail F_Pass F_Fail <br /> F_Pass F Fail F_Pass F_Fail <br /> F_Pass F_Fail r-Pass r-Fail <br /> Simulated leak at far ends of the interstitial space. F_! Visual Inspection <br /> How was interstitial communication verified? I- Other(Describe the method in section XV below.) F1 Gauge <br /> Was the vacuum or pressure restored to operating levels in all interstitial spaces? FV_ Yes F_ 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 /> COULDNT TEST COMMUNICATION IN DSL TANK#1 FILL SUMP... <br /> GPH = Gallons per hour, Y=Yes, N = No, NA= Not applicable, VPH =Vacuum/Pressure/Hydrostatic, ID = Identification <br />