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Underground Storage Tank Release Detection Equipment Testing Report Form 17. LINE LEAK DETECTOR TEST RESULTS x Check this box if line leak detectors ARE NOT installed. (Do not complete this section.) ❑ Check this box if Appendix 5.2 continuation page is attached. Simulated release rate verified: (Check all that apply.) Yes No NA ❑ 3 GPH ❑ 0.1 GPH (Required only if LLD performs line tightness testing) Has the testing equipment been properly calibrated? ❑ ❑ ❑ For emergency tank systems, does the LLD create an audible and visual alarm ❑ ❑ ❑ when a release is detected? ❑ ❑ For mechanical LLDs, does the LLD restrict the flow through the pipe when a ❑ ❑ ❑ release is detected? For electronic LLDs, does the pressure supply pump automatically shut off when ❑ ❑ ❑ a release is detected? For electronic LLDs, does the pressure supply pump automatically shut off if the ❑ ❑ ❑ monitoring system or LLD is disabled or disconnected? ❑ For electronic LLDs, does the pressure supply pump automatically shut off if the ❑ ❑ ❑ monitoring system or LLD malfunctions or fails a tightness test? ❑ For electronic LLDs, have ail accessible wiring connections been visually ❑ ❑ ❑ inspected for kinks and breaks? Were all items on the equipment manufacturer's maintenance checklist ❑ ❑ ❑ completed? Were all LLDs confirmed operational within regulatory requirements? ❑ ❑ ❑ List only line leak detectors tested. 1 LLD ID LLD Model Lines Monitored Pass Fafl ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 0 ❑ ❑ ❑ ❑ ❑ ❑ ❑ Describe all answers marked "No" or "Fail" and the proposed remedy in Section S. List all equipment either replaced or repaired (including cleaning or adjustment) in Section B. Page 4 of 6