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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page 6 of s) <br /> XII . 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? <br /> (Check all that apply ) Simulated leak rate verified ❑X 3 GPH ❑ 0 1 GPM ❑ 0. 2 GPH a ❑ <br /> Was the testing apparatus properly calibrated ? X ❑ ❑ <br /> For emergency generator tank systems does the LLD create an audible and visual alarm when a leak is detected ? ❑ ❑ Q <br /> For mechanical LLDs , does the LLD restrict the flow through the pipe when a leak is detected? ❑ ❑ X <br /> For electronic LI.Ds does the turbine automatically shut off when a leak is detected ? X ❑ ❑ <br /> For electronic LLDs does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected ? Q ❑ <br /> For electronic LLDs , does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? ❑X ❑ ❑ <br /> For electronic LLDs , have all accessible wiring connections been visually inspected for kinks and breaks? ❑X ❑ ❑ <br /> Were all items on the equipment manufacturer 's maintenance checklist completed? X1 ❑ <br /> Were all LLDs confirmed operational within regulatory requirements? Q ❑ <br /> El <br /> For any answer of "N" above, describe in Section X111 how and when these issues were or will be corrected. <br /> XIII . COMMENTS <br /> XIV. VACUUM 1 PRESSURE / HYDROSTATIC MONITORING EQUIPMENT TESTING <br /> X❑ Check this box if VPH monitoring is NOT used . (Do not complete this section ) <br /> This section must be completed if VPN monitoring is used to perform leak detection monitoring. <br /> System Type (Mark all that apply ) ❑ Vacuum ❑ Pressure ❑ Hydrostatic <br /> Sensor ID Component(S) Monitored By This Sensor Sensor Functionality Interstitial Communication <br /> Test Test <br /> ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> ❑ Pass ❑ Fad ❑ Pass ❑ Fail <br /> ❑ Pass ❑ Fail I ❑ Pass ❑ Fail <br /> ❑ Pass ❑ Fail I ❑ Pass ❑ Fail <br /> ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> ❑ Pass ❑ Fall ❑ Pass ❑ Fail <br /> ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> ❑ Pass ❑ Fait ❑ Pass ❑ Fail <br /> ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> How was interstitial communication verified ? ❑ Simulated Leak at Far Ends of the Interstitial Space ❑ Visual Inspection <br /> ❑ Other (Describe the method in section XV below ) Gauge <br /> Was the vacuum or pressure restored to operating levels in all interstitial spaces? ❑ Yes [:] 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 Appircable VPH = Vacuum/pressure/Hydrostatic, 10 = Idewcation <br />