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Monitoring System Certification - Pag,- , of 3 <br />Site Address: 4315 Waterloo Rd <br />D. Results of Testing/Servicing <br />Software Version Installed: 119.02 <br />Complete the following checklist: <br />Date of Testing/Servicing: 05/10/01 <br />El Yes <br />❑ No* <br />Is the audible alarm operational? <br />0 Yes <br />❑ No* <br />Is the visual alarm operational? <br />0 Yes <br />❑ No* <br />Were all sensors visually inspected, functionally tested, and confirmed operational? <br />H1 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 />El Yes <br />❑ No* <br />If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) <br />❑ N/A <br />operational? <br />0 Yes <br />❑ No* <br />For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment <br />❑ N"A <br />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) X Sump/Trench Sensors; ❑ Dispenser Containment Sensors. <br />Did you confirm positive shut -down due to leaks and sensor failure/disconnection? X 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 />H1 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 ro erl ? If so, at what percent of tank capacity does the alarm trigger? % <br />❑ Yes* <br />IR 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 />❑x 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 />El Yes <br />❑ No* <br />Was monitoring system set-up reviewed to ensure proper settings? Attach set-up reports, if applicable.) <br />El Yes <br />❑ No* <br />Is all monitoring equipment oerational per manufacturer's specifications? <br />* In Section E below, describe how and when these deficiencies were or will be corrected. <br />E. Comments: <br />UN -036 - 3/6 http://www.unidocs.org Rev. 08/22/00 <br />