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Underground Storage Tank <br /> Monitoring System Certification Form <br /> T. LINF LEAK DETE TOR TESTING <br /> TQ Check this box if line leak detectors ARE NOT installed. (Do not complete this sectlDn.) <br /> Simulated release rate verified: (Check all that apply,) Yes No NA <br /> GPH 17 0.1 GPH El 0-2 GPH <br /> Has the tesfing apparatus been properly calibrated? r <br /> For emergency generator tank systems, does the LLD create an audible and visual rl r In <br /> alarm when a leak is detected? <br /> For mechanical LLDs, does the LLD restrict the flow through the pipe when a 0 El 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 autornatirally shut off if any portion of the <br /> monitodng system Is d lea bled or disconnected? <br /> For electronic LLDs, does the turbine automatically shut off if any portion of the El ❑ El <br /> rnonitorin g system malfunctions or fails a tig htness test? <br /> For electronic LLD9, have all accessible wiring connections been visually inspected <br /> for kinks and breaks? <br /> Were all items on the equipment manufacturers maintenance checklist oompleted? <br /> Were all LLDs confirmed operational within regulatory requirements? <br /> LLD fD LLD Model Liras Monitored Pass Fail <br /> T1 F 1 DV Diesel Product RV & 19 0 ® � <br /> T2 99 LD-2000 Diesel Product 21-30 ® � <br /> T9 99 LD- 000 Diesel Product 21- 0 El 17 <br /> T4 FX1V Unleaded Product El El <br /> T9 99-LD2000 Premium Product ] <br /> T6 FX1D11 Auto Diesel Product 1-12 I� <br /> 0 0 <br /> El 0 <br /> � 0 <br /> Describe all answers marks} "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 />