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Underground Storage Tank <br /> Monitoring System Certification Form <br /> 1. LINE LEAK DETECTOR TESTING <br /> LJ Check this box if line leak detectors ARE NOT installed. (Do not complete this section.) <br /> Simulated release rate verified: (Check all that apply.) Yes Na I <br /> ® 3 GPH LJ 0.1 GPH Ll 0.2 GPH <br /> Has the testing apparatus been properly calibrated? <br /> For emergency generator tank systems, does the LLD create an audible and visual <br /> alarm when a leak is detected? <br /> For mechanical LLDs, does the LLD restrict the flaw through the pipe when a ® D El <br /> release is detected? <br /> For electronic LLDs, does the turbine automatically shut off when a release is <br /> detected? <br /> For electronic LLDs, does the turbine automatically shut off if any portion of the <br /> monitoring system is disabled or disconnected? <br /> For electronic LLDs, does the turbine automatically shut off if any portion of the LJ J V <br /> monitoring system malfunctions or fails a tightness test? <br /> For electronic LLDs, have all accessible wiring connections been visually inspected 1j <br /> for kinks and breaks? <br /> Were all items on the equipment manufacturer's maintenance checklist completed? ® Ll El <br /> Were all LLDs confirmed operational within regulatory requirements? R1 D Ej <br /> LLD ID LLD Madel Limes Monitored ,Pass Fail <br /> T4 LD-2000 RUL.PROD.LINE ® 0 <br /> T5 LD-2000 MUL.PROD.LINE ® 11 <br /> T6 LD-2000 PUL.PROD.LINE ® 0 <br /> Ll Ll <br /> Ll Ij <br /> Il Ij <br /> Ll U <br /> L1 Li <br /> L] Ll <br /> 11 D <br /> El I1 <br /> I, I, <br /> Describe all answers marked "No"or"Fail'and proposed remedy it Section 9. <br /> List all monitoring equipment either replaced or repaired in Section 9 <br /> Page 4 of 6 <br />