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Underground Storage Tank <br />Monitoring System Certification Form <br />7. LINE LEAK DETECTOR TESTING <br />❑Check this box if line leak detectors ARE NOT installed. (Do not complete this section.) <br />Simulated release rate verified: (Check all that apply.) <br />Yes <br />No <br />NA <br />x3 GPH ❑0.1 GPH❑0.2 GPH <br />91 <br />X <br />❑ <br />Has the testing apparatus been properly calibrated? <br />x <br />❑ <br />❑ <br />For emergency generator tank systems, does the LLD create an audible and visual alarm <br />❑ <br />❑ <br />when a leak is detected? <br />❑ <br />x <br />For mechanical LLDs, does the LLD restrict the flow through the pipe when a release is <br />❑ <br />❑ <br />x <br />detected? <br />❑ <br />❑ <br />For electronic LLDs, does the turbine automatically shut off when a release is detected? <br />x <br />❑ <br />❑ <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring <br />x <br />❑ <br />system is disabled or disconnected? <br />❑ <br />For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring <br />x <br />❑ <br />system malfunctions or fails a tightness test? <br />For electronic LLDs, have all accessible wiring connections been visually inspected for <br />x <br />❑ <br />❑ <br />kinks and breaks? <br />Were all items on the equipment manufacturer's maintenance checklist completed? <br />x <br />❑ <br />❑ <br />Were all LLDs confirmed operational within regulatory requirements? <br />x <br />❑ <br />❑ <br />LLD ID <br />LLD Model <br />Lines Monitored <br />Pass <br />Fail <br />Q2 <br />V/R 8484 <br />91 <br />X <br />❑ <br />03 <br />VIR 8484 <br />87 <br />X <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />Describe all answers marked "No" or "Fail" and proposed remedy in Section 9. <br />List all monitoring equipment either replaced or repaired in Section 9 <br />Page 4 of 6 <br />