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Site Address! Date_ Date of Icsting/Servicing: ����-!_ <br /> A. Results otTesting/Servicing DRAFT <br /> Software Version Installed- <br /> Complete the following checklist: <br /> Yes ❑ Now Is the audible alarm operational) <br /> Yes Cl Now Is the visual alarm operational? <br /> Yes ❑ Now I 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 ro er operation? <br /> ❑ Yes ❑ Now If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) <br /> N/A operational? <br /> O Yes Now For pressurized piping systcros, 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 afl that appl)) ❑Sump/Trench Sensors; ❑Dispenser Containment Sensors. <br /> Did you confirm positive shut-down due to leaks and sensor failure/disconnection7 ❑ Yes; ❑ No. <br /> es ❑ Now For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no <br /> /Amechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at Ute tank <br /> M1point(s)and operating properlv7 If so,at what percent of tank capacity does the alarm trigger? a ! % <br /> O Yes* No Was any monitoring equipment replaced? If yes,identify specific sensors,probes,or other equipmrnt replaced <br /> and list the manufacturer name and model for all replacement parts in Section E,below. <br /> Cl Yes• 'No Was liquid found inside any secondary containment systems designed as dry systcros? (Check all that apgh) <br /> Cl Product; ❑Water. if yes,describe causes in Section E,below, <br /> Yes ❑ NO I Was monitoring system set-op reviewed to ensure proper settings? <br /> Yes ❑ No" Is all monitoring equipment operational per manufacturer's speciflcatiorn? <br /> •In Section E below,describe how and when these deficiencies were or will be corrected. <br /> E. Comments; <br /> CALM-01 Page 2 of 3 ttltsl44 <br />