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Mar, 26. 2013 2:26PM Donlee Pump Co. No, 2155 P. 1 <br />Monitoring System Certification <br />D. Results of Testing/Servicing <br />Software Venion installed: 39A .61 <br />r.nmnlpta the fnlinwinw rhpckliat- <br />RECEIVE® <br />MAR 2 6 2013 <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />Yes <br />❑ No* <br />Is the audible alarm operational? <br />Yes <br />❑ No* <br />Is the visual alarm. operational? <br />It Yes <br />❑ No* <br />Were all sensors visually inspected, functionally tested, and confirmed operational? <br />40 Yes <br />❑ No* <br />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 <br />❑ No* <br />If alarms are relayed to a remote monitoring station, is all communications equipment (e.g., modem) <br />11 N/A <br />operational? <br />41M Yes <br />❑ No* <br />For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment <br />❑ N/A <br />mouitoriag system detects a leak, fails to operate, or is electrically disconnected? If yes: -which sensors initiate <br />positive shut -down? (Check all that apph) it l Sump/Trencb Sensors; *Dispenser Containment Sensors. <br />Did you confirm positive shut -down due to leaks id sensor failure/disconnection? ig Yes; ❑ No. <br />❑ Yes <br />❑ NO <br />For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no <br />JB N/A <br />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? °/n <br />L_1 Yes* <br />* No <br />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* <br />49 No <br />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 />W Yes <br />❑ No* <br />Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports if applicable <br />IS Yes <br />❑ No* I <br />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 />F. Comments: <br />n- 611111AD <br />