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M <br /> A Results of Testing/Servicing s' <br /> Software Version Installed: /L50( 1 <br /> Complete the following checklist: <br /> Yes ❑ No* Is the audible alarm operational? <br /> Ld"Ves ❑ No* Is the visual alarm operational? <br /> JW'Y—es ❑ No* Were all sensors visually inspected,functionally tested,and confirmed operational? <br /> 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 /> )0'N/A operational? <br /> 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) Sensors;.B')Sispenser Containment Sensors. <br /> Did you confirmpositive shut-down due to leaks and sensor failure/disconnection?mss; ❑No. <br /> ❑ Yes ❑ No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no <br /> ,Z N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank <br /> SII oin s and operating roerl ? If so,at what percent of tank capacity does the alarm trigger? % <br /> ❑ Yes* 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 d No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) ❑ <br /> Product; L)Water. If es,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 9perational per manufacturer's specifications? <br /> * In Section E below,describe how and when these deficiencies were or will be corrected. <br /> E. Comments: <br /> Page 2 of 3 03/01 <br />