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Monitoring Systern Certification <br />D. Results of Testing/Servicing <br />Software Version Installed: -3,140-01 <br />Complete the followiney checklist: <br />V Yes <br />❑ No* <br />Is the audible alarm operational? <br />® Yes <br />❑ No* <br />Is the visual alarm operational? <br />fflYes <br />El No' <br />Were all sensors visuallyinspected, functionally tested, and confirmed operational? <br />Q Yes <br />0 No* <br />Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will <br />not interfere with their proper operation? <br />0 Yes <br />❑ No* <br />If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) <br />i <br />❑ N/A <br />operational? <br />Id Yes <br />❑ No* <br />For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment <br />0 N/A <br />monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate <br />positive shut -down? (Check all that apply)10 Sump/Trench Sensors; �1 Dispenser Containment Sensors. <br />Did you confirm positive shut -down due to leaks and sensor failure/disconnection? P Yes; ❑ No. <br />Yes <br />Q No* <br />For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no <br />❑ N/A <br />mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank <br />fill point(s) and operating ro ern 7 If so, at what percent of tank ca aci does the alarm tri er? �% <br />j ❑ Yes* <br />0 No <br />Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced <br />and list the manufacturer name and model for all replacement parts in Section E, below. <br />0 Yes* <br />$2 No <br />Was liquid found inside any secondary containment systems designed as dry systems? (Check all that appl}) ❑ <br />Product; O Water. If yes, describe causes in Section E. below. <br />I Yes <br />-Yes <br />❑ No* <br />Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable <br />FW <br />❑ No* <br />Is all monitoring a ui mentoperational per manufacturer's specifications? <br />* In Section E below, describe how and when these deficiencies were or will be corrected. <br />t rwAi ' .r s <br />gueKPS, udelsi 4 /: o a..%tel <br />•� - ' i / <br />UN -0311- 2/4 Page 2 of7 Rev. 06/04;01 <br />www.uridocs.org <br />