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UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM Page 6 of a) XII. LINE LEAK DETECTOR TESTING Fsecdon k this box if line leak detectors (LLD) are NOT Installed. (Do not complete this section.) Y N NA ust be completed if LLDs are installed. Was a leak simulated to verify LLD performance? ® ❑ ❑ Check all that app&j Simulated leak rate verified: 10 3 GPH ❑ 0. 1 GPH 0.2 GPH Was the testing apparatus properly calibrated? ® ❑ ❑ 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? ® ❑ ❑ For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? ® ❑ ❑ For electronic LLDs, have all accessible wiring connections been visually inspected for kinks and breaks? ® ❑ ❑ Were all items on the equipment manufacturers maintenance checklist completed? ® ❑ ❑ Were all LLDs confirmed operational within regulatory requirements? ® ❑ ❑ For any answer of "N" above describe in section X11 how and when these issues were or will be corrected. XIII. COMMENTS XIV. VACUUM / PRESSURE/ 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 Sensor Functionality Interstitial Communication Sensor ID Component(s) Monitored by this Sensor Test Test ❑ Pass ❑ Fail ❑ Pass Cl Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fall ❑ 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 ❑ 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.) Foran answer of "FAIL" above describe in section XV how and when these issues were or will be corrected. XV. COMMENTS i i nPN a ralkum nPr hN it Y a Voa N o Nn Ne = Nnt anrs1kW4o VPH a Van n m ProaaumMvdwvo r in a kw tmralinn i