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RECEIVED, <br /> D. Results of Testing/Servicing JUN 0 2 2014 <br /> Software Version Installed: 132.00 ENVIRONMENTAL HEALTH <br /> Complete the following checklist: DEPARTMENT <br /> ki Yes ❑ No* Is the audible alarm operational? <br /> Yes ❑ No* Is the visual alarm operational? <br /> K] Yes ❑ No* Were all sensors visually inspected,functionally tested,and confirmed operational? <br /> ki Yes ❑ No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their <br /> proper operation? <br /> ki Yes ❑ No* If alarms are relayed to a remote monitoring station,is all communications equipment(e.g.modem)operational? <br /> ❑ N/A <br /> ❑ Yes ❑ No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monitoring system <br /> ❑ N/A detects a leak,fails to operate,or is electrically disconnected? If yes:which sensors initiate positive shut-down? (Check all that apply) <br /> [OSump/Trench Sensors; E]Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor <br /> failure/disconnection? ®Yes; []No. <br /> - <br /> R Yes ❑ No* For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.no mechanical overfill prevention <br /> poi N/A valve is installed),is the overfill warning alarm visible and audible at the tank fill point(s)and operating properly? If so,at what percent <br /> of tank capacity does the alarm trigger? 90 % <br /> ❑ Yes* )e No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the <br /> manufacturer name and model for all replacement parts in Section E,below. <br /> ❑ Yes* C No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply)(3Product; OWater. If <br /> es,describe causes in Section E,below. <br /> c Yes ❑ No* Was monitoring system set-up reviewed to ensure proper settings?Attach set up reports,if applicable <br /> C Yes U No* Is all monitoring equipment operational per manufacturer's specifications? <br /> *In Section E below,describe how and when these deficiencies were or will be corrected. <br /> E. Comments: <br /> Monitoring System Certification Page of 12/07 <br />