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Underground Storage Tank <br />Monitoring System Certification Form <br />7.LINE LEAK DETECTOR TESTING <br />fl 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 No NAI3GPHflO.1GPH fl O.2GPH <br />Has the testing apparatus been properly calibrated?in in <br />For emergency generator tank systems,does the LLD create an audible and visual inalarmwhenaleakisdetected? <br />For mechanical LLDs,does the LLD restrict the flow through the pipe when a in inreleaseisdetected? <br />For electronic LLDs,does the turbine automatically shut off when a release is indetected? <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 <br />monitoring_system_malfunctions_or_fails_a_tightness_test? <br />For electronic LLDs,have all accessible wiring connections been visually inspected E in inforkinksandbreaks? <br />Were all items on the equipment manufacturer’s maintenance checklist completed?in in <br />Were all LLDs confirmed operational within regulatory requirements?in j in <br />LLD ID LLD Model Lines Monitored —Pass Fail <br />Qi 648480 87 Line E in <br />Q2 848480 91 Line <br />inn <br />nfl <br />nfl <br />inn <br />inn <br />fir <br />inn <br />inn <br />inn <br />inn <br />Describe all answers marked “No”or “Fail”and proposed remedy in Section 9. <br />List all monitoring equipment either replaced or repaired in Section 9 <br />Page 4 of 6