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Underground Storage Tank <br /> Release Detection Equipment Testing Report Form <br /> 7. LINE LEAK DETECTOR TEST RESULTS <br /> ❑ Check this box if line leak detectors ARE NOT installed. (Do not complete this section.) <br /> ❑ Check this box if Appendix 5.2 continuation page is attached. <br /> Simulated release rate verified: (Check all that apply.) <br /> ❑ 3 GPH ❑ 0.1 GPH (Required only if LLD performs line tightness testing) Yes No NA <br /> Has the testing equipment been properly calibrated? ❑ ❑ ❑ <br /> For emergency tank systems, does the LLD create an audible and visual alarm ❑ ❑ ❑ <br /> when a release 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 pressure supply pump automatically shut off when a ❑ ❑ ❑ <br /> release is detected? <br /> For electronic LLDs, does the pressure supply pump automatically shut off if the ❑ ❑ ❑ <br /> monitoring system or LLD is disabled or disconnected? <br /> For electronic LLDs, does the pressure supply pump automatically shut off if the ❑ ❑ ❑ <br /> monitoring system or LLD malfunctions or fails a tightness test? <br /> For electronic LLDs, have all accessible wiring connections been visually ❑ ❑ ❑ <br /> inspected for kinks and breaks? <br /> Were all items on the equipment manufacturer's maintenance checklist ❑ ❑ ❑ <br /> completed? <br /> Were all LLDs confirmed operational within regulatory requirements? ❑ ❑ ❑ <br /> List only line leak detectors tested. <br /> LLD ID LLD Model Lines Monitored Pass Fail <br /> Q1 Veeder-Root PLLD Unleaded 91 Line ❑ ❑ <br /> MLLD 2 Veeder-Root PLLD Unleaded 87 Line ❑ ❑ <br /> MLLD 3 Veeder-Root PLLD Diesel Line ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> Describe all answers marked "No"or"Fail"and the proposed remedy in Section 8. <br /> List all equipment either replaced or repaired (including cleaning or adjustment) in Section 8. <br /> Page 4of5 <br />