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Monitoring System Certification <br /> REDEn i <br /> D. Results of Testing/Servicing [�c 9 2017 <br /> Software Version Installed: ENVIRONMENTAL HEALTH <br /> Complete the followin checklist: ngm <br /> FOO <br /> Y�e <br /> s �EOI <br /> o* Is the audible alarm operational? <br /> so* Isthe visual alarm operational �El <br /> ? <br /> I Yes 1 ❑ 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 <br /> not interfere with their proper operation? <br /> ❑ Yes ❑ No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g., modem) <br /> 1� N/A operational? <br /> J Yes ❑ No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment <br /> ❑ N/A 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) IV Sump/Trench Sensors; (Dispenser Containment Sensors. <br /> Did you confirm positive shut-down due to leaks and sensor failure/disconnection? W Yes; []No. <br /> ❑ Yes ❑ No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no <br /> I� N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank <br /> fill point(s)and operating properly? If so,at what percent of tank capacity does the alarm trigger? % <br /> ❑ Yes* 14 No 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 /> ❑ Yes* X No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) <br /> ❑Product; ❑ Water. If yes,describe causes in Section E,below. <br /> 06 Yes ❑ No* Was monitoring system set-up reviewed to ensure proper settings?Attach set up reports,if applicable <br /> Yes ❑ 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 /> UN-036—3/6 www.unidocs.org Rev.01/17/08 <br />