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RECEIVED <br /> Monitoring system Certification NOV 2 0 2014 <br /> A. Rtsulla of Testing/Servicing ENVIRONMENTAL HEALTH <br /> Software version Installed: 329,01 DEPARTMENT <br /> Complete the followin cheddist•. <br /> W Yes ❑ No" Is the audible alarm opewional? <br /> M Yes ❑ No' is the visual alarm opentional? <br /> ® Yes ❑ No" Were all sensors visualh inspected,functionally tested,and confirmed operational? <br /> I@ Yes ❑ No' were all sensors installed at lowest point of secondary containment and positioned so that other equipment will <br /> not interfere with their I roper operation? <br /> ❑ Yes ❑ Ne' If alarms are relayed.to. a remote monitoring station, is all wmmunicatioas equipment (v.&, modem) <br /> ® N/A operational? <br /> 0 Yes ❑ No' For pressurized piping!ysrems,does the turbine automatically shut down if the piping secondary containment <br /> ❑ N/A monitoring system detens a leak,fails to uperate,or is eicctrically diocormucted? If yes:which sensors initiate <br /> positive shut-down? (C heck all that apply) ®Sumpgrench Sensors; ❑Dispense Containment Sensors. <br /> Did you confirm positive shut-down due to leaks and sensor hailure/disconnection? ®Yes; ❑NJ <br /> ❑ Yes [INe' For tank systems that utilize the enwhoring system as the primary tank overall warning device (i.e., no <br /> ® NIA mechanical overfill pre rention valve is installed),is the overfill warning alarm vis lobe and audible az the tank <br /> fill point(s)and operating properly? 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' 0 No Was liquid found inside:any secondary containment systems designed as dry systems? (Check all that apply) <br /> Q Product; ❑Water. lfyes,describe causes in Section E,below. <br /> Yes E7 No" Was monitoring system set-up reviewed to ensure proper settings?Attach get reports,if applicable <br /> Yes ❑ do• 1 Is all monitoring equipment operational per manufacturer's specifications? <br /> 'In Seetinn E below,describe how and when these defteiencies were or will be corrected, <br /> E. Comments: <br /> Page 2 of 4 <br /> 6'd £968948602 wne aled a qei eb eb£b0 b L OZ^oN <br />