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08/24/2004 09:51 91692744 CHAMPION PT IN: PAGE 04 <br /> Mrudtoriq+4z Svttem Certircz6on • <br /> Siw Address: <br /> Date of Testing/Servicing: - 4 <br /> A Results''of Tewag/Servicing <br /> JOft. lrt Version installed: - <br /> T—fo- <br /> 0 <br /> win chIs the andihle alarm nal?Is the visual alarm orw?Wereisuallof 5atcdonall tested and cotdnnased 7 <br /> Were ail sensors installed ai lowest point al'secondary cvnrainroen[ and positioned so that otherequipmentwill tta rttet9i re with meix on7Y alarmsaxerelire toanxigotemogi"AgsMdm is all cuiumn onlious egtxipment (e. modemN/Aoperadonid? g )For pmsm zed piping sys=s, does the mrbuieautomatically stmt dawn i€themoni piping secoodatycontautmtemtaring aystmd detects a leak fails to opemtc ors� tally discorurecxed7� ��s: vvtticlt sensors <br /> nitiate positive shat down? (Check a!1 nkat apply) umpTreuch Sensors; CFrDispeuser CantainvcntSensors.DU yon confirm positive shnt-dacm due to leaks and sensor fa4wddisw anection? Yes; CINo. <br /> a ❑ Noy For tank systems that otilfze the monitoring system as theprimary tank overfill <br /> ❑ NIA mwhanical avedli wamvtg device (l.c. 00 <br /> prevention valve is installed). is the ave&ll warning alarm visible aaad andible at the tank <br /> fill aiq s and ? ff so,at what zCent aLdmggoed <br /> ;-d <br /> act does tate alarm tri 7??7"n Y S' <br /> q Xes* No Was any monitoring equiptgent rep,rM7 if y� i c Seim, des, ar other egrripotetrt <br /> laced and list the mairAc arer name and model for all in Secdoa E,below, <br /> ❑ Yes+ No Was liquid fooad inside aniy secondary cantaimtent systemas dry systems'? (Check all that apply) <br /> ❑Product ❑ 9V'ater. if d`=be causes in Section E,es ❑ No* Was ria m set- reviewed m cnsutk In Yes ❑ No* . montonin taufac"Mesons7 <br /> ba SeCd=E belaiv,de scribe how and when these deficiencies were or well be corrected, <br /> E. Comments: <br />