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�nitoring System Certification <br /> Site Address: 2500 W. LODI AVE. Date of Testing/Service: 09/29/2004 <br /> a LOWER SACRAMENTO RD. <br /> D. Results of Testing/Servicing <br /> Software Version Installed: 16.02 <br /> Complete the following checklist: <br /> X Yes No• Is the audible alarm operational? <br /> 0 Yes Ej No` Is the visual alarm operational? <br /> ❑X Yes No• Were all sensors visually inspected,functionally tested,and confirmed operational? <br /> Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not <br /> Q Yes ❑No- interfere with their proper operation? <br /> Yes n No` X N/A If alarms are relayed to a remote monitoring station, is all communications equipment(e.g.modem)operational? <br /> For pressurized piping systems,does the turbine automatically shut down if the piping secondary containment <br /> © Yes ❑No• ❑N/A monitoring system detects a leak,fails to operate,or is electrically disconnected?If yes:which sensors initiate positive <br /> shut-down?(check all that apply) ❑X Sump/Trench Sensors; 0 Dispenser Containment Sensors. <br /> Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ❑x Yes ❑No <br /> For tank systems that utilize the monitoring system as the primary tank overfill warning device(Le.:no mechanical <br /> 1:1 Yes El No• Qx NIA <br /> overfill prevention valve is installed),is the overfill warning alarm visible and audible at the tank fill points(s)and operating <br /> properly? If so,at what percent of tank capacity does the alarm trigger? i <br /> ❑ Yes- ©No Was any monitoring equipment replaced?If yes,identify speck sensors,probes,or other equipment replaced and list the <br /> manufacturer name and model for all replacement parts in Section E,below. <br /> ❑ Yes` ©No Was liquid found inside any secondary containment systems designed as dry systems?(check all that apply) ❑Product; <br /> ❑ Water. If yes,describe causes in Section E,below. <br /> © Yes ❑No. Was monitoring system set-up reviewed to ensure proper settings?Attach set-up reports,if applicable. <br /> © Yes ❑No- Is all monitoring equipment operational per manufacturers'specifications? <br /> *In Section E below,describe how and when these deficiences were or will be corrected. <br /> E. Comments: <br /> page 2 of 3 <br />