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6/5/209:58 PM FROM: Fax Alltech TO: 468-3433 2*002 OF 003 <br /> A Results of Testing/Servicing <br /> Software Version Installed:N.A. <br /> Complete the following checklist: <br /> ® Yes ❑ No* Is the audible alarm operational? <br /> ® Yes ❑No* Is the visual alarm operational? <br /> ® Yes ❑ No* Is the print function operational? ❑Not installed. <br /> ® 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 <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)operational? <br /> ®N/A <br /> ® 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) ❑ Sump/Trench Sensors; ❑Dispenser Containment Sensors. <br /> Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ❑Yes; ❑No. <br /> ❑Yes ❑No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no <br /> ®N/A mechanical overfill prevention valve is installed),is the overfill warning alarm visible and audible at the tank fill <br /> point(s) and operating ro erl ? If so,at what percent of tank capacity does the alarm trigger? <br /> ❑Yes* ®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* ® 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 /> ® Yes ❑ No* Was monitor system set-upreviewed to ensure proper settings?Attach set u reports,if applicable <br /> ® Yes E] NO: <br /> Is all monitoring equipment oerational per manufacturer's specifications? <br /> *In Section E below,describe how and when these deficiencies were or will be corrected. <br /> E. Comments: <br /> Page 2 of 3 03/01 <br />