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JUL-03-2002 14:29 SOUTHLAND CORP NW DIV. 503 977 7711 P. 11i19 <br /> r Mon ng System Certification <br /> Site Address: 1399 N. MAIN ST. Date of Testing/Servlce: 06/1112002 <br /> P.NORTHGATE <br /> D. Results of Testing/Servicing <br /> Software Version Installed: <br /> Complete the following checklist: <br /> x Yee I Ej No. Is the audible alarm operational? <br /> MX Yes No' I Is the visual alarm operational? <br /> QX Yee No• Were all sensors visually inspected,functionally tested,and confirmed operational? <br /> El77 Ware all sensors installed at lowest point of secondary contalnment and positioned so that other equipment will not <br /> 175 Yee t No• interfere with their proper operation? <br /> Yes No• F1 N/A If alarms are relayed to a remote monitoring station,is all communications equipment(e.g.modem)operational? <br /> For prossurized piping systems,does the turbine automatically shut down If the piping secondary containment <br /> © Yes ❑No' ❑N/A monitoring system detects a leak,fails to operate,or is electrically disconnected?If yes:which sensors Initiate positive <br /> shut-down?(check all that apply) ❑x Sump/Trench sensors: Q Dispenser containment Sensois. <br /> Did you confirm positive shutdown due to leaks and sensor failure/disconnactioO [E Yee No <br /> * NIA For tank systems that utilize the monitoring system aa the primary tank overfill warning device(Le.:no mechanical <br /> © Yes []No ❑ overfill prevention valve Is installed),Is the overfill waming alarm visible and audible at the tank fill polnts(s)and operating <br /> properly? If so,at what percent of tank capacity does the alarm trigger? go X_ <br /> El Yea• ©No Was any monitoring equipment replaced?It yes,Identify specific sensors,probes.or other equipment replaced and list the <br /> 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) Product <br /> ❑ Water. If yes,describe causes In Section E,below. <br /> © Yes No' Was monitoring system sat-up reviewed to ensure proper settings?Attach set-up reports,if applicable. <br /> © Yes No• Is all monitoring equipment operational per manufacturers'specifications? <br /> In Section E below,describe how and when these deflaonces were or will be corrected. <br /> E. Comments: <br /> page 2 of 3 <br />