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REGENED <br /> E <br /> NOV 0 2 2016 <br /> 1). Results of Testing/Servicing ENVIRONMENTAL HEALTH <br /> Software Version Installed: 326.01 DEPARTMENT <br /> Complete the following checklist: <br /> ® Yes i No' Is the audible alarm operational? <br /> 0 Yes i No* Is the visual alarm operational? <br /> • Yes E No* Were all sensors visually inspected,functionally tested,and confirmed operational? <br /> © Yes I No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their <br /> proper operation? <br /> • Yes I No* If alarms are relayed to a remote monitoring station,is all communications equipment(e.gr modem)operational? <br /> N/A <br /> • Yes l No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monftoring system <br /> I NIA detects a leak,fails to operate,or is electrically disconnected? If yes:which sensors initiate positive shut-down? (Check all that apply) <br /> Q SumprTrench Sensors; © Dispenser Containment Sensors. Did you confirm pcsitive shut-down due to leaks and sensor <br /> _ <br /> fail ureldisconnection? Yes; I. No.. <br /> YesNo* For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e. no mechanical overfill prevention <br /> Q N/A valve is installed),is the overfill warning alarm visible and audible at the tank fill point(s)and operating properly? If so,at what percent <br /> of tank capacity does the alarm trigger? % <br /> IT Yes* ❑ No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the <br /> manufacturer name and model for all replacement parts in Section E,below. <br /> Yes* Q No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) Product; Water. If <br /> es,describe causes in Section E,below. <br /> C Yes I No* Was monitoring system set-up reviewed to ensure proper settings?Attach set up reports,if applicable <br /> Yes [7 No* Is all monitoring equipment operational per manufacturers specifications? <br /> *In Section E below,describe how and when these deficiencies were or will be corrected. <br /> E. Comments: <br /> L2 . Diesel STP Sump Brine Sensor 304 <br /> L4 Diesel STP Sump Brine Sensor 304 <br /> L6 Diesel Fill Sump Brine Sensor 304 <br /> L8 Diesel Fill Sump Brine Sensor 304 <br /> 1_11 Vent Sump Sensor - 208 <br /> L12 Vent Sump Sensor Brine 304 <br /> L14 Dispenser 13 Sensor Brine 304 <br /> L16 Dispenser 14 Sensor Brine 304 <br /> L18 Dispenser 15 Sensor Brine 304 <br /> L20 Dispenser 16 Sensor Brine 304 <br /> L22 Dispenser 17 Sensor Brine 304 <br /> L24 Dispenser 18 Sensor Brine 304 <br /> Monitoring System Certification Page 2 of 5 12!47 <br /> 2/21107 <br />