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POB 36 26515 N. SACTO. BL. )ntinuouS Monitoring; <br /> #f�xx �x,. (`�,e1B# THORNTON, CA. 95686 Device Certification <br /> 209 794-0102 800 524-9087 <br /> TEST DATE <br /> SITE: / <br /> OPERATOR OWNER <br /> SITE ADDRESS gip V <br /> / ADDRESS <br /> PHONE <br /> (-2DJ) -Z P11 ONE <br /> pq� �Pn�pr]� <br /> MAKE AND MODEL OF MONITORING SYSTEM /)Jt?] <br /> Contents of Tank 1 N 4u,� (A�/ic, 0-k <br /> Capacity of Tank <br /> Type of Product Line: (Gravity, Suction, Pressure) (f IQ G <br /> INDICATE LOCATION OF THE MONITORING SENSORS TESTED BY PLACING A YES OR NO IN APPLICABLE BOX'. <br /> Annular Space Sensor <br /> Sump Sensor ti70 iw A)(] N a <br /> Y�hC <br /> Containment Sensor ,rJ D <br /> Electronic Overfill/Level C `®l'l 4) b P(] AR) a5 <br /> Electronic In-Line Leak Detector 1„)0 aJ 6 u D <br /> I v�ma j17WA 7N <br /> Mechanical Line Leak Detector No• "., F..;. ; <br /> In Tank Gauging Device I �� <br /> INDICATE THE FOLLOWING BY PLACING A YES OR NO IN APPLICABLE BOX: <br /> Does the monitoring system have audible and visual alarms? YD 5 V2 9 Ye S r• <br /> Does the turbine automatically shut-down if the system detects <br /> a leak, falls to operate or is electronically disconnected? <br /> Is the monitoring system installed to prevent unauthorized tampering? yoc <br /> Is the monitoring system operable as per the manufacturer's specifications? <br /> Which continuous monitoring devices Initiate positive shut-down of the turbine? X ,i --- <br /> CERTIFIED TESTER'S ID# <br /> SIGNATURE OF CERTIFIED TECHNICIAN <br /> PRINTED NAME OF CERTIFIED TECHNICIANIL4 I ice"t <br />