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RECEIVED D. Results of Testing/Servicing JUN 14 2017 Software Version Installed: 120.02 ENVIRONMENTAL HEALTH Complete the following checklist: DEPARTMENT ❑X Yes ❑No* Is the audible alarm operational? ❑X Yes ❑No* Is the visual alarm operational? Q Yes ❑No* Were all sensors visually inspected, functionally tested,and confirmed operational? ❑X Yes ❑No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? ❑ Yes ❑No* If alarms are relayed to a remote monitoring station,is all communications equipment(e.g.modem) ❑X N/A operational? ❑ Yes ❑No* For pressurized piping systems,does the turbine automatically shut down if the piping secondary ❑X N/A containment monitoring system detects a leak,fails to operate,or is electrically disconnected?Ifyes:which sensors initiate positive shut-down?(Check all that apply) ❑Sump/Trench Sensors; ❑DispenserContainmentSensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ❑Yes; ❑No. ❑ Yes ❑No* For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.no mechanical overfill prevention valve is installed),is the ovetfill warning alarm visible and audible at the 0 N/A tank fill point(s)and operating properly?If so, at what percent of tank capacity does the alarm trigger? =Yes- 0 No Was any monitoring equipment replaced?If yes,identify specific sensors,probes,or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E,below. ❑Yes* ❑X No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) ❑Product; ❑Water.If yes,describe causes in Section E,below. ❑X Yes ❑No* Was monitoring system set-up reviewed to ensure proper settings?Attach set up reports,if applicable ❑X Yes ❑No* Is all monitoring equipment operational per manufacturer's specifications? *In Section E below,describe how and when these deficiencies were orwill be corrected. E. Comments: Other sensors from page one: L16: Waste Oil drain pan sensor :794380-208 Certified