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Underground Storage Tank <br /> Monitoring System Certification Form <br /> `• LINE LEAK DETECTOR TESTING <br /> Q 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 /> 3 GPH r7 0.1 GPH El 0-2 GPH <br /> Has the tesfing 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 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 ❑ ❑ ❑ <br /> rnonitorin a system malfunctions or fails a tig hwtness test? <br /> For electronic LLD9, have all accessible wiring connections been visually inspected ❑ 0 ❑ <br /> for kinks and breaks? <br /> Were all items on the equipment manufacturers maintenance checklist oompleted? [l� 8 ❑ <br /> Were all LLDs confirmed operational within regulatory requirements? 0 ❑ 0 <br /> LLD fD LLD Model Lire&S Monitored Pass Fail <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ 0 <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ 0 <br /> Describe all answers marked "No"or "Fall"and proposed remedy in Section 9. <br /> List all monitoring equipment either replaced or repaired in Section 9 <br /> Page 4 of 6 <br />