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07/21/2008 15:41 FAX fa 003 <br /> n3. �:esaua�.ts tai"�'t:s�nuzrJiwsva�,nrn , <br /> Sollwarc Version Installed: <br /> Com Clete the following checklist_ _ <br /> Yes U Nu* is the audible alarm operational? _ <br /> Yes U No* Is the visual Ilam operalionxl`? '— —�� <br /> ;lCl Yes ❑ 'No* Were all sensors visually inspected, functionally tested,and confirmed operational'? <br /> Yes C] No Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will <br /> not interfere with their proper rtLeration? <br /> U Yes U No* If alaruls are relayed to a remote monitoring station, is all communications equipment (e.g. modam) <br /> QK /A operational? <br /> /L:1 Ycs Q No* For pressurized piping systems, does the turbine automaticallyshut down if the <br /> U N/A monitoring ' piping,secondary containment <br /> system detects a leak, foils ut oper te, or is electrically disco nected7 If yes: which sensors initiate <br /> positive shut-down? (C'herk all that appWyJ Sitmp/Trcrlch Sensors;�L)ispenser Containment Sensor's. <br /> Did you Coll Arm positive shut-down due to leaks and sensor fhl lure/discoanectinn? Yes; ❑.No. <br /> ❑ Yes L� No* For tank systems that utilize the monitoring system as. the prunary tank overfill wanting device (i.e, no <br /> f� N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank <br /> r'• 1 fill oint(s)and operating properly'1 if so, at whcity does the alarm trigger? <br /> CI Yes* ld No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced <br /> and list die manufacturer name and model for all replacement parts in Section F. below. <br /> ❑ Yes* p' No Was liquid found inside any secondwy containment systems designed as dry systems? (Check all that apply) ❑ <br /> Product; U Wate�es, describe causes in Section 1,below. <br /> LJ Yes ❑ No* Was monitoring system set-up reviewed to ensure proper setkaks?Attach set up rupnrts, if applicable <br /> Yes ❑ No* Ts all monitoring equipment u LTational per manufacturer's specifications? <br /> * in Section R below,describe how and when these deficiencies were or will be corrected. <br /> T. Comments: <br /> Page 2 of 3 03/01 <br />