COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page 5 of 6) XII . LINE LEAK DETECTOR TESTING ❑ Check this box if line leak detectors (LLD) are NOT installed . (Do not complete this section.) Y N NA This section must be completed if LLDs are installed. Was a leak simulated to verify LLD performance? © ❑ ❑ (Check all that apply.) Simulated leak rate verified : ® 3 GPH ❑ 0. 1 GPH ❑ 0.2 GPH Was the testing apparatus properly calibrated? ❑✓ _ _El _ ❑ For emergency generator tank systems , does the LLD create an audible and visual alarm when a leak is detected? For mechanical LLDs , does the LLD restrict the flow through the pipe when a leak is detected ? � �� —�� _ �- _© ❑ ❑ , For 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 disconnected? ❑ ❑ w _W1 j For electronic LLDs , does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? ❑ ❑ W1 For electronic LLDs , have all accessible wiring connections been visually inspected for kinks and breaks? _ ❑ ❑ Were all items on the equipment manufacturer's maintenance checklist completed? ❑ ❑ Were all LLDs confirmed operational within regulatory requirements? ✓❑ ❑ ❑ For any answer of "N" above, describe In Section Xlll how and when these issues were or will be corrected. XIII . COMMENTS �I i i I XIV. VACUUM I PRESSURE 1 HYDROSTATIC MONITORING EQUIPMENT TESTING ❑ Check this box if VPH monitoring is NOT used . (Do not complete this section.) This section must be completed if VPH monitoring is used to perform leak detection monitoring. System Type (Mark all that apply.) ❑ Vacuum ❑ Pressure ❑ Hydrostatic i Sensor ID Camponent(S} Monitored By This Sensor Sensor Functionality Interstitial Communication Test Test ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail [ ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail L] Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass — ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ___ _u �.—_ ----- ❑ Pass ❑ Fail ❑ Pass_ ❑ Fail How was interstitial communication verified? Simulated Leak at Far Ends of the Interstitial Space Visual Inspection -_ ❑ Other (Describe the method in section XV below.) ❑ Gauge Was the vacuum or pressure restored to operating levels in all interstitial spaces? ❑ Yes ❑ No (Describe the reason in section XV below.) For any answer of "Fail' above, describe in Section XV how and when these issues were or will be corrected. XV. COMMENTS i I i f GPH = Gallons Per Hour, Y = Yes, N = No, NA = Not Applicable, VPH = VacuurmPressure"drostatic, ID = Identification