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Underground Storage Tank <br /> Release Detection Equipment Testing Report Form <br /> 7. LINE LEAF{ DETECTOR TESL' RESULT <br /> ❑ G heck this box if line leak detectors ARE NOT installed. (Do not complete this section) <br /> 0 Check this box if Appendix 5.2 continuation page is attached. <br /> Simulated release rate verifier . (Check all that apply.) Yes No NA <br /> ❑ 3 OPH 10.1 OPH (Required only if LLD performs lure tightness testing) <br /> Has the testing eq ' meet been properly calibrated? ❑ ❑ 0— <br /> Fa r errmergency tank stems. does the LLD create an audible and visa alarm ❑ ❑ 13 <br /> where a release is dete d? <br /> 1=or mechanical LLDs, d the LLD restrict the flow thro�rgh the pi whe€i a ❑ ❑ ❑ <br /> release is detected' <br /> For electronic LLDs, does the\essure supply pump automatically shut off when ❑ ❑ 0 <br /> a release fs detected? <br /> For electronic LLDs, does the supply pump autom Ecally shut off if the ❑ ❑monitorin s stem or LLD is dr disconnected? <br /> For electfanic LLDs, does the pressure upply pump autrnatically shut off if the ❑ <br /> monitoring system or LLD malfunctions o ails a ti htrx6ss test? <br /> For electronic LLDs, have all accessible it conne6tians been visually ❑ ❑ ❑ <br /> inspected for kinks and breaks? <br /> Were all items on the equipment manufacturer's aintenance checklist ❑ ❑ ❑ <br /> completed? <br /> Were all LLDs confirmed operational within regulatory quirernents'? ❑ C� ❑ <br /> List only line leak defectors tested. <br /> LLD ID LLD Model tines nitored Pass Fail <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> Describe all answers marked Wo" or'Fail" and the proposed remedy in Section 8_ <br /> List all equipment eithor replaced or repaired(inducting cleaning or ad}ustmant} in Section a- <br /> Page 4 of 6 <br />