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Underground Storage Tank Release Detection Equipment Testing Report Form 7. LINE LEAK DETECTOR TEST RESULTS ❑ Check this box if line leak detectors ARE NOT installed. (Dc not complete this section.) © Check this box if Appendix 5-2 continuation page is attached. imulated release rate verified: (Check all that apply.) M3GPH ❑ 0.1 G PH (Required on if LLD performs lure tightness testing) Yes No IN,A Has the testing equipment been properly calibrated? 21 ❑ ❑ 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? O El p For electronic LLDs, does the pressure supply pump automatically shut off if the _monitoring systern or LLD is disabled or disconnected? El ❑ ❑ For electronic LLDs, does the pressure supply pump automatically shut off if the monitoring system or LLD malftinGtions or fails a tightness test? 0 ❑ Q For electronic LLDs, have all accessible wiring connections been visually inspected for kinks and breaks? 171 El ❑ © ❑ ❑ Were all items ort the egUipment manufacturer's maintenance checklist completed' Were all LLDs confirrr7ed operational within regulatory requirements? ❑ ❑ ❑ L.rs# only Brie leak detectors tested_ LLD ID LLD Model Furies Monitored Pass Fail Q1 848480 87 El ❑ 02 848480 91 0 ❑ Q# 848480 DSL Q ❑ ❑ D ❑ 0 ❑ 13 ❑ Q ❑ 11 l❑ ❑ ❑ ❑ ❑ fl Describe all answers marked "11fo" or `Far'lu and the proposed remedy in Section 8. List all equipment either replaced or repaired (including cleaning or adjustment) in Sectlon & Page 4 c f 6