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Underground Storage Tank <br /> Monitoring System Certification Form <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.) <br /> 3 GPH 0.1 GPH 17 0.2 GPH <br /> N, <br /> Has the testing apparatus been properly calibrated? <br /> gen <br /> For emergency erator tank systems, does the LLD create an audible and visual <br /> alarm when a leak is detected? ❑ in 1 <br /> For mechanical LLDs, does the LLD restrict the flow through the pipe when a <br /> release is detected? 0 ® F f <br /> For electronic LLDs, does the turbine automatically shut-off a release is <br /> detected? <br /> For electronic LLDs, does the turbine automatically shut off if any portion of the <br /> -- <br /> monitoring system is disabled or disconnected? 17 <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? r P7 <br /> Were all items on the equipment manufacturer's maintenance checklist completed? ®x <br /> Were all LLDs confirmed operational within regulatory requirements? <br /> LLD /DLLD Model Lines Monitored Pass Fail <br /> T# 1 PLLD regular <br /> T# 2 PLLD super <br /> rif <br /> ❑ ❑ <br /> in El <br /> ❑ ❑ <br /> in In <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 />