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02/18/2004 15:21 40897101 SSS INC PAGE 03 <br /> ,cesults ai'Testing/Servicing <br /> software Version Installed: <br /> Complete the following checklist, <br /> CI Yes ❑ No* Is the audible alarm o erationai? <br /> Yes ❑ No" Is the visual alarm o crational? <br /> Q Yes O No* Were all sensors visually inspected, functionally tested, and confirmed Operational? <br /> ❑ Yes ❑ Nu' Werc all sensors installed at lowest point of secondary containment and positioned so the: ether equipment will <br /> not interfere with their proper o oration? <br /> ❑ Yes Q No* If alarms are relayed to a remote monitoring station, is all communications equipment (e,g. modern) <br /> ❑ N/A operational? <br /> ❑ Yes ❑ No* For pressurized piping systems, sloes the turbine automatically shut down if the piping secondary contalTIMLnt <br /> ❑ NIA monitoring system doWuLs it leaf'., fails to operatc,yr is clootrioally disconnected? If yec' which sensors initiate <br /> positive shut-down? (Check all that upp4y) C] Sumpqrench Sensors; Ll 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 /> i ❑ N/A mechanical overfill prevention valve is installed), is tate overfill warning alarm visible and audible at the tank <br /> rill jjoisit(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? <br /> 0/0 <br /> ❑ Yes" D 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 r5placement parts in Section E,below. <br /> CI Yes* U No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) <br /> I... , p I'roduot, ❑ Water'. IT yes,describe'cau€es in Section E.below_ <br /> Q Yes ❑ No* Was monitoring s stem set-up reviewed to ensure Rrugg settings?Attach set L%2 re orts,if applicable <br /> ❑ 3'es ❑ No* is all monitoring equipment o crational per manufacturer's specifications? <br /> *In Section E below.describe how and when these deficiencies were or will be corrected. <br /> E. Comments: <br /> Pale 2 of 3 03/01 <br />