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Monitoring System Certification-Pao of 3 <br /> Site Address: 1071 N.Main St. Date of Testing/Servicing: 3-7-2001 <br /> D. Results of Testing/Servicing <br /> Software Version Installed: 19 <br /> Complete the following checklist: <br /> ❑x Yes ❑ No* Is the audible alarm operational'? <br /> ❑x Yes ❑ No* Is the visual alarm o erational? <br /> El Yes ❑ No* Were all sensors visual) inspected, functional) tested,and confirmed operational? <br /> E 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 /> 1] Yes ❑ No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) <br /> ❑ NIA operational? <br /> p Yes ❑ No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment <br /> Ll 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? 0 Yes; ❑No. <br /> U Yes ❑ No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no <br /> El N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank <br /> fill pints and operating ro erl ? If so,at what percent of tank capacity does the alarm trigger? °x, <br /> ❑ Yes* El 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* 1] 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 F,below. <br /> d Yes ❑ No* Was monitoringsystem set-u reviewed to ensure proper settings? attach set-upre arts, i a livable. <br /> fl Yes ❑ No* Is all monitoring a ui mentoperational per manufacturer's specifications? <br /> *In Section E below,describe how and when these deficiencies were or will be corrected. <br /> E. Comments: <br /> UN-036-316 http://www.unidoes.org Rev.08/22/00 <br />