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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 ARC. NOT installed. (Do not complete this section-) <br /> b Check this box if Appendix 5.2 continua#ion page is attaches}. <br /> Simulated r ease rate verified: (Check all that apply-) Yes No NA <br /> ❑ 3 G PH ❑ 0.1 GPk (Required only if LLD performs line fi fitness sfirr ) <br /> Has the testing a ipment been properly calibrated? ❑ ❑ ❑ <br /> For emergency tank stems, does the LLb create an audible and vi 6aI alarm ❑ Q ❑ <br /> when a release is dete d? <br /> For mechanical LLDs. d 011kt <br /> he LLD restrict the flow through the/elpe when a ❑ ❑ ❑ <br /> release is detected'? _ <br /> For electronic LLDs, does the essrare supply pump automatically shut off when ❑ ❑ ❑ <br /> a release is detected`? <br /> For electronic LLDs, does the prey ure supply pump automatically strut off if the R ❑ ❑ <br /> m on itori ng system cr LLD is disable�Ivr disconnected? <br /> For electronic LLDs. does the press re Lj pp ly pump a utorna tica I ly shut off if the Q E3 ❑ <br /> m on itori ng system or LLD maIfunctions o #ails a tiq htness test? <br /> For electronic LLDs. have all accessible w connections been visually ❑ ❑ 0 <br /> inspected for kinks and breaks? <br /> Were all items on the equipment manufacture ' maintenance checklist ❑ [3 ❑ <br /> completed? <br /> Were a I I LLDs ccnfirrrred operationaI within regulatory requirements? ❑ C] ❑ <br /> List only lure leak detectors tested. <br /> LLD ID LLD Model Lines Monitored Pass Fail <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ l7 <br /> ❑ ❑ <br /> 0 ❑ <br /> ❑ I 12 <br /> ❑ Q <br /> ❑ ❑ <br /> ❑ Q <br /> Describe all answers marked Wo" or "Fair and the proposed remedy in Section 8. <br /> List all equipment either replaced or repaired including cleaning or adjustment) in Section a. <br /> Page 4 of 6 <br />