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*1100 <br /> Monitoring System Certification <br /> Site Address: Date of Tesung/Serricimg <br /> 0. Results of TestingiServicing <br /> Software Version installed: <br /> COWJAM the fol " checklist: <br /> No* fs the audible alarm o rattonai? — <br /> ❑ No* Is the visual alarm operabonaP <br /> ❑ No* Were all sensors visually inspected,ftractionafty tested,and confirmed operationall <br /> Yes ❑ No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment : <br /> will not interfere with their proper operation? <br /> ❑ Yes 1 ❑ * If alarms are relayed to a remote monitoring dation, is all commtmications equipment (e.g. modem) . <br /> E: MA operational? <br /> ❑ Yes No* For pressurized piping systems, does the turbine automatically slit down if the piping secondary containment <br /> I ❑ N/A monitoring system detects a leak, fails m operate, or is electicaily disconnected? ff yes: which sensors <br /> initiate positive shut-down? (Check all that apply) ❑ Sump/Trench Sensors; ❑ Dispenser Cortautaient <br /> Sensors. <br /> Did von confirm positive shat-dvwtt due to teaks and sensor failure/disconnecrion? ❑Yes, ❑No. <br /> `fes 0 * For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. oo <br /> N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank <br /> M s)and ? If so,at what percent of tank capeaty does the alarm trigpr TTM <br /> ❑ Yes* No Was any monitoring equipment replaced? if ves, identify specific sensors probes, or other equipment <br /> replaced and list the manufacturer name and model for aII replacement pans in Section E, below. <br /> V" Yess <br /> No Was ligaid found inside any secondary containment systems designed as dry systems? (Check all chat appiv) <br /> ❑Product; ❑ Water. If es, describe causes in Section E.below. <br /> ❑ No* Was monitoringsystem set-upreviewed to ensure r settings? _ <br /> f ❑ No* is all morntonn meatonal oer mamiilicturer's - ours? — �) <br /> to Section E blow,describe how and when these deficiencies were or will be corrected <br /> E. Cumments. i ' C A ce r <s t l S 1,�T i,"ot t o t�r la 5 e L <br /> L. ;n le-,;j eej <br />