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• • RECEIVED <br /> FEB 2 e2014 <br /> D.Results of Testing/Servicing <br /> So ENVIRONMENTAL <br /> Software Version Installed: 17.01 <br /> HEALTH DEPARTMENT <br /> Complete the following checklist: <br /> Yes No* s the audible alar operational? <br /> • Yes NO s the visual alar operational? <br /> • Yes No* Nere all sensors visually inspected,functionally tested,and confirmed operational? <br /> Yes No* ere all sensors installed at lowest point of secondary containment and positioned so that other equipment will not Interfere with <br /> heir pro er operation? <br /> Yes No* f alarms are relayed to a remote monitoring station,is all communications equipment(e.g.modem)operational? <br /> • N/A <br /> • YesENoFor pressurized piping systems,does the turbine automatically shut down if the piping secondary containment monitoring <br /> stem detects a leak,fails to operate,or is electrically disconnected?If yes:which sensors Initiate positive shut-down?(Check <br /> all that apply)r.Sump/Trench Sensors; r Dispenser Containment Sensors. <br /> Did you confrm positive shut-down due to leaks and sensor failure/disconnection?C± Yes; r No <br /> YesFor tank systems that utilize the monitoring system as the primary tank ovefill warning device(i.e.no mechanical overfill <br /> prevention valve is installed),is the overfill warning alar visible and audible at the tank fill point(s)and operating properly?If <br /> o at what ercent of tank ca aci does the alarm trier?90% <br /> Yes* as any monitoring equipment replaced?If yes,identify specific sensors,probes,or other equipment replaced and list the <br /> anufacturer name and model for all replacement its in Section E below. <br /> 'a Yes* • No as liquid found=any secondary containment systems designed as dry systems?(Check all that apply) <br /> Product: r Water.If es describe causes in Section E below. <br /> • Yes C No* as monitoring system set-up reviewed to ensure proper settings?Attach set up reports,If applicable <br /> Yes No* 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 /> Replaced the ATG float kit on the 91 tank.Veeder-Root part number 849600-000. <br /> Monitoring System Certification Page 2 of 3 12/07 <br />