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Monitoring System Certification-Page 2 of 3 <br /> RECEI' ' <br /> Site Address: 1987 W. 11th St. Date of Testin�/Servicing: 11113114 <br /> DLC 1i2014 <br /> D. Results of Testing/Servicing <br /> Software Version Installed- 329.02 ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> Complete the foliowin checklist: <br /> 0 Yes ❑ No* Is the audible alarm operational? <br /> ® Yes ❑ No* Is the visual alarm operational'? <br /> W Yes ❑ No* Were all sensors visually inspected,functionally tested,and confirmed operational? <br /> 0 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 0 No* If alarms are relayed to a remote monitoring station,is all communications equipment(e.g.modem) <br /> ❑ N/A operational? <br /> ❑ Yes 0 No* For pressurized piping systems,does the turbine automatically shut down if the piping secondary containment <br /> 0 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) ❑ Sump/Trench Sensors; ❑ Dispenser Containment Sensors. <br /> Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ❑ 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 properly? If so,at what percent of tank capacity does the alarm trigger? 90 <br /> ® Yes* 0 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* ® 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 1 0 No* I Was monit ring system set-up reviewed to ensure proper settings? (Attach set-up reports, il'a licable.) <br /> ® Yes 1 ❑ No* I Is all monitoring equipment operational per manufacturer's specifications? <br /> *In Section JE;below,describe how and when these deficiencies were or will be corrected. <br /> E. Comments: Monitor Certification performed for Permit Final due to replacement of Overfill Alarm <br /> components & Interval Timer. <br />