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Site Address: SS#9600, 1250 N WILSON WAY,STOCKTON Date of Testing/Servicing: 0 L t( Zf <br /> D. Results of Testing/Servicing M <br /> Software Version Installed: (Jl <br /> Complete the following checklist: <br /> Yes ❑ No* Is the audible alarm operational? <br /> 14 Yes ❑ No* Is the visual alarm operational? <br /> E Yes ❑ No* Were all sensors visually inspected, functionally tested,and confirmed operational? <br /> V] 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 /> 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) PSump/Trench Sensors; [Dispenser Containment Sensors. <br /> Did you confirm positive shut-down due to leaks and sensor failure/disconnection? 1:9.Yes; ❑No. <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 point(s)and operating ro erl ? 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* 'la No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) ❑ <br /> Product; ❑ Water. If yes,describe causes in Section E,below. <br /> Yes ❑ No* Was monitoring system set-up reviewed to ensure proper settings? <br /> Yes ❑ No* Is all monitoring equipment oerational per manufacturer's specifications? <br /> •In Section E below,describe how and when these deficiencies were or will be corrected. <br /> E. Comments: 0j p&Y, 5C � ) —Z O &a- Am 44C s 5 1 S 5Z1 <br /> Page 2 of 3 03101 <br />