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Underground Storage Tank Monitoring System Certification Form 10 LINE LEAK DETECTOR TESTING ❑ Check this box if line leak detectors ARE NOT installed. (Do not complete this section.) Simulated release rate verified: (Check all that apply.) Yes No NA p 3 GPH ❑ 0.1 GPH ❑ 0.2 GPH Has the testing apparatus been properly calibrated? ❑ ❑ For emergency generator tank systems, does the LLD create an audible and visual ❑ El02alarm when a leak is detected? For mechanical LLDs, does the LLD restrict the flow through the pipe when a ❑✓ ElElrelease is detected? For electronic LLDs, does the turbine automatically shut off when a release is ❑ ❑ 0 detected? For electronic LLDs, does the turbine automatically shut off if any portion of the ❑ ❑ 0 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 tightness test? For electronic LLDs, have all accessible wiring connections been visually inspected ❑ ❑ 0 for kinks and breaks? Were all items on the equipment manufacturer's maintenance checklist completed? ❑✓ ❑ ❑ Were all LLDs confirmed operational within regulatory requirements? ❑✓ ❑ ❑ LLD ID LLD Model Lines Monitored Pass Fail 87 STP MLD 87 ❑ 91 99 LD 2000 91 0 ❑ DIESEL STP MLD -D DIESEL 0 ❑ DIESEL A 116-056 DIESEL 0 ❑ DIESEL B 99 LD 2000 DIESEL 0 ❑ RED DIESEL STP MLD RED DIESEL 0 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Describe all answers marked "No" or "Fail" and proposed remedy in Section 9. List all monitoring equipment either replaced or repaired in Section 9 Page 4 of 6