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RECEIVED <br /> NOV 2 8 2017 <br /> D. Results of Testing/Servicing A <br /> Software Version Installed: ENVIRONMENTAL HEALTH <br /> Complete the followinchecklist: DEPARTMENT <br /> ® Yes ❑ No* Is the audible alarm operational? <br /> ® Yes ❑ No* Is the visual alarm operational? <br /> ® Yes ❑ No* 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 not interfere with their proper <br /> operation? <br /> ❑ Yes ❑ No* If alarms are relayed to a remote monitoring station,is all communications equipment(e.g.,modem)operational? <br /> ® N/A <br /> ® Yes ❑ No* For pressurized piping systems,does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak, <br /> ❑ N/A fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check all that apply) ® Sumplrrench <br /> 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 mechanical overfill prevention valve is <br /> ® N/A installed),is the overfill warning alarm visible and audible at the tank fill point(s)and operating properly? If so,at what percent of tank capacity <br /> does the alarm trigger? % <br /> ❑ Yes ® No Was any monitoring equipment replaced? If yes,identify specific sensors,probes,or other equipment replaced and list the manufacturer name <br /> 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 ® No* Was monitoring system set-up reviewed to ensure proper settings?Attach sex up reports,if applicable <br /> ❑ Yes ® No* Is all monitoring equipment operational per manufacturer's specifications? <br /> *In Section E below,describe how and when these deficiencies were or will be corrected. <br /> E. Comments: PRINTER DOES NOT PRINT OUT ALARMS DURING TEST <br /> Monitoring System Certification Page 2 of 4 2/21/07 <br />