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UNDERGROUND STORAGE TANK MONITORING QvuTE :" 10 ERR EORPq (Page v of �) 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? 0 ❑ ❑ (Check all that apply.) Simulated leak rate verified : © 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? ❑ ❑ Q 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? ❑ ❑ 0 For electronic LLDs , have all accessible wiring connections been visually inspected for kinks and breaks? ❑ ❑ 0 Were all items on the equipment manufacturer' s maintenance checklist completed? ® ❑ ❑ Were all LLDs confirmed operational within regulatory requirements? ✓❑ ❑ ❑ For any answer of 'W " above, describe in Section X111 how and when these Issues were or will be corrected. XIII . COMMENTS Replaced 87 LD2000 Leak Detector - Retested & Passed . XIV. VACUUM / PRESSURE J 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 ID Component(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 j ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail C ❑ Pass ❑ Fall ❑ Pass ❑ Fail [ ❑ Pass ❑ Fail I ❑ Pass ❑ Fail How was interstitial communication verified ? [] Simulated Leak ai 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 GPH = Gallons Per Hour, Y = Yes, N = No, NA = Not Applicable, VPH = Vacuumfpressum iydrostatic, ID = Identification l