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Underground Storage Tank Release Detection Equipment Testing Report Form 7. LINE LEAK DETECTOR TEST RESULTS 9 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.) ❑ 3 GPH ❑ 0.1 GPH (Required only if LLD performs line tightness testing) Yes No NA 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? El 1:1 ❑ For mechanical LLDs, does the LLD restrict the flow through the pipe when a release is detected? El 1:1 ❑ 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 all 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. LLD ID LLD Model Lines Monitored Pass Fail ❑ ❑ ❑ 0 - IT ❑ EL ❑ ❑ ❑ ❑ ❑ EL ❑ Describe all answers marked "No" or "Fail" and the proposed remedy in Section 8. List all equipment either replaced or repaired (including cleaning or adjustment) in Section 8. Page 4 of 6