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l" -litoring System Certification <br /> Site Address 3400 N.MACARTHUR DR N..,/ <br /> Date of Testing/Service: 02/25/2011 <br /> D. Results of Testing/Servicing <br /> Software Version Installed: 329.01 <br /> Complete the following checklist: <br /> FX1 Yes No' Is the audible alar operational? <br /> Q Yes No' Is the visual alar operational? <br /> Q Yes No' Were all sensors visually inspected,functionally tested,and confirmed operational? <br /> ❑ Yes ❑No' Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not <br /> interfere with their proper operation? <br /> Yes _LjNo' X N/A If alarms are relayed to a remote monitoring station,is all communications equipment(e.g.modem)operational? <br /> For pressurized piping systems,does the turbine automatically shut down if the piping secondary containment <br /> ❑X Yes ❑No• ❑N/A monitoring system detects a leak,fails to operate,or is electrically disconnected?If yes:which sensors initiate positive <br /> shut-down?(check all that apply) ❑X Sump/Trench Sensors; ❑X Dispenser Containment Sensors. <br /> Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ❑X Yes ❑No <br /> ❑X Yes ❑No• ❑N/A For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.:no mechanical <br /> overfill prevention valve is installed),is the overfill warning alarm visible and audible at the tank fill points(s)and operating <br /> properly? If so,at what percent of tank capacity does the alarm trigger so <br /> ❑ Yes' ❑X 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' X❑No Was liquid found inside any secondary containment systems designed as dry systems?(check all that apply) ❑Product; <br /> ❑ Water. If yes,describe causes in Section E,below. <br /> ❑X Yes ❑No Was monitoring system set-up reviewed to ensure proper settings?Attach set-up reports,if applicable. <br /> ❑X Yes ❑No• Is all monitoring equipment operational per manufacturers'specifications? <br /> In Section E below,describe how and when these deficiences were or will be corrected. <br /> E. Comments: <br /> Page 2 of 3 Based on CA form dated 03/08 <br />