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.p i • <br /> monitoring System Certification <br /> D. Results of Testing/Servicing <br /> Software Version installed-,123.02 <br /> Complete the following checklist- <br /> [@ Yes I ❑ No* is the audible alarm operational? <br /> M Yes ❑ No* Is the visual alarm esatiottal? <br /> 0 Yes ❑ No* Were all sensors visual! ins ted,functional) tested,and confirmed erational.? <br /> ® Yes ❑ No* Were all sensors installed at lowest point of secondary containment and positioned so that outer equipment will <br /> not interfere with their aero oration? <br /> 0 Yes a No* if alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) <br /> 13 N/A operational? <br /> 1131 Yes 13 No* For pressurized piping systems, does the turbine automatically sbut down if the piping secondary cori;mment <br /> ❑ NIA monitoring system detects a leak, fails to operate, or is electrically disconnected? if yes:whichsensors initiate <br /> positive 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 /> ❑ Yes ❑ No* For tank systems that utilize the monitoring system as the primary tank overfill warning donee (i.e. n.o <br /> [S) NiA mechanical overfill prevention valve is installed), is the overfill wamistg alarm visible and audible at the tank <br /> fill oint s and o cretin Properly? If so,at what percent of tank capacity does the alarm tri r? % <br /> ❑ yes* 191 No Was any monitoring equipment repiaced? If yes, identify specific sensors,probes, or other equipment replaced <br /> and list the manufacturer nam4a and model for all replacement arts in Section la,below. <br /> [kJ Yes* No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) ❑ <br /> Product,, x Water. If yes,describe causes in Section E.below. <br /> I$J Yes ❑ No* Was manitorin s tem set-11T%reviewed to ensure o er settin s?Attach set u reports iFs licable <br /> fxl Yes ❑ No* is all monitoring e i ment o eratimal 2E manufacturer's specifications? <br /> * In Section E below,describe bow and when these deficiiencies were or will be corrected. <br /> F. Comments: Remated lid gaskets <br /> UN-036- page 2 of 3 Rev.p6M4101 <br />