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A Results ofTesting/Servicing <br /> Software Version Installed: <br /> Complete the fol[owing checklist: <br /> IQ Yes ❑ No* Is the audible alarm operational? <br /> M Yes ❑ No* Is the visual alarm operational? <br /> M Yes ❑ No* Were all sensors visually inspected,functionally tested,and confirmed operational? <br /> 421 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 /> ❑ Yes ❑ No* If alarms are relayed to a remote monitoring station; is all communications equipment (e.g. modem) <br /> Ii N/A operational? <br /> 67 Yes ❑ No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment <br /> ❑ 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) 0 Sump/Tren�h Sensors; ❑Dispenser Containm nt Sensors. <br /> Did you confirmpositive shut-down due to leaks and sensop failureldisconnection? Ll V..: <br /> WNo. <br /> ❑ Yes ❑ .No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no <br /> N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank <br /> fill oint(s)and operating ro rl ? If so,at what percent of tank capacity does the alarm trigger.? <br /> ❑ Yes* 8 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* M No Was liquid found inside any secondary containment systema designed as dry systems? (Check all that apply) ❑ <br /> Product; ❑Water. If yes,describe causes in Section E,below. <br /> G`Yes ❑ No* Was monitoring system set-up reviewed to ensure proper settings?Attach set up reports,if applicable <br /> ❑ Yes lH No* Is all monim ' equipment 2tional per manufacturer's�s ifications? <br /> *In Section E below,describe how and when these deficiencies were or will be corrected. <br /> I <br /> E. Comments: Sl a a " iso ES n1o'I S q u—r e L• "7tU Rj l NlE5 <br /> 11IfE iE,Ylt1A)k.5 fR96219Mk0 A-r CfJb or c i2Yrr-i 4-r,, 1 <br /> I; <br /> Page2of3 �,jp <br /> 03/01 <br /> L <br />