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AUG-12-2010 09:11 Service Station Systems 408 938 8888 P.03 <br /> Monitoring System Certification-Pt 01`3 <br /> Site Address: 6425 N. Pacific Ave. Date of Testing/Servicing; <br /> D. Results of Testing/Servicing <br /> Software Version installed- <br /> Com tete the following checklist: <br /> Yes a No* Is the audible alarm operational? <br /> Yes 0 No* Is the visual alarm operational l <br /> ❑ Yes a No* Were all sensors visually inspected, functionally tested,and confirmed orational? <br /> 0 Yes 0 No* Were all sensors installed at lowest point of secondary containme nd positioned so that other equipment will <br /> not interfcrc with their proper operation? <br /> 4kYes 0 No* If alarms are relayed to a remote monitoring station, is all munications equipment(e.,.modem) <br /> ❑ N/A o rational? <br /> ❑ Yes ❑ No* For pressurized piping systems, does theZopera <br /> aticakly shut down if the piping secondary containment <br /> ❑ N/A monitoring system detects a leak,fails toelectrically disconnected? If yes: which sensors initiate <br /> positive shut down? (Check all that applrench Sensors; Dispenser Containment Sensors. <br /> Did ou confirm positive shut-down dueensor failure/disconnection? 0 Yes a No <br /> 0 Yes ❑ No* For tank systems that utilize the moniUrhng system as the primary tank overfill warning device(i.e. no <br /> 0 N/A mechanical overfill prevention valy is installed), is the overfill warning alarm visible and audible at the tank <br /> fill point(s) and operating prope ? if so, at what percent of tank capacity does the alarm trigger? % <br /> 0 Yes* ❑ No Was any monitoring equipme replaced? If yes, identify spocific sensors,probes,or other equipment replaced <br /> and list the manufacturer n e and model for all replacement parts in Section E, below. <br /> 0 Yes* ❑ No Was liquid found inside Any secondary containment systems designed as dry systems? (Check all that apply) <br /> 0 Product;❑ Watcrzlf yes,describe causes in Section E,below. <br /> 0 Yes 0 No* Was monitoring s tent set-up reviewed to ensure ro er settings? Attach set-u re orfs, i a licable. <br /> 0 Yes 0 No* Is all monitoring equipment operational per manufacturer's specifications? <br /> * In Section E below,describe how <br /> and when these deficiencies were or will be corrected. <br /> E. Comments: 2h5 6 Z- 9 7-Z e (�� U.tl is <br />