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Underground Storage Tank <br /> Monitoring System Certification Form <br /> Z LINE LEAK DETECTOR TESTING <br /> ❑ 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 NA <br /> 23 GPH ❑ 0 . 1 GPH 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 flow through the pipe when a ❑✓ ❑ ❑ <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 ❑ ❑ <br /> monitoring system malfunctions or fails a tightness test ? <br /> For electronic LLDs , have all accessible wiring connections been visually inspected ❑ ❑ ❑ <br /> for kinks and breaks ? <br /> Were all items on the equipment manufacturer's maintenance checklist completed ? ✓❑ ❑ ❑ <br /> Were all LLDs confirmed operational within regulatory requirements ? ❑✓ ❑ ❑ <br /> LLD ID LLD Model Lines Monitored Pass Fail <br /> Tank 1 RJ 116 -057-5 Regular ❑✓ ❑ <br /> Tank 2 Fe Petro STP MLD Premium ❑✓ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> El <br /> ❑ ❑ <br /> ❑ ❑ <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 <br />