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01/02/1995 03:27 2097! CALAVEPAS ENV FE A PAGE 02 <br /> /-2 <br /> 6or ito-'rg System Certiflcst$oli <br /> Fa iEty Name: <br /> 1)atcw i�nnp�crvuing:` <br /> I/y�G <br /> D_ Results of TestingJServicing <br /> complete the foilo checklist: <br /> a Yes Q No' Is the monitoring system o rational manufacturer's s cifications'? <br /> 0 Yes O No' 1s the audible alarm operational? <br /> CI Yes 0 No' Is the visual,alarm a tioaal? <br /> rivc, <br /> Yes0 No' Were all sensors visually ted,tene and confirmed o &none!? <br /> Yes0 No, Were all scasots and robes reinstalled pr rOf <br /> 0 No' Is an monitoringa ui raeflt sccwcd froth unauthorized ria . <br /> 0 No' If slartas are rcl&ycd to a rcmotc motiitonny swoon is all cotntnunicarioas equtpancat (c-g- madam) <br /> Cl N/A operatio"I? <br /> D Nos If needed by any monitoring equipment,are replscemcnt fiats and/or batteries available? <br /> y yvA <br /> CI Ycs O No• For p msw-=cd piping systems,does the turbine automatically sheat down if the piping secondary contxiamrnt <br /> Q NIA rnottitonng system detects a teak.fails to operate,or is electrically disconnected? If yes: which stnsors initiate <br /> positive shut-dawn? (Check all that app(y) O Swrtp/Trencb Sensors; O Dispenser Contxinatmt ScL'Sars. <br /> Did you confirm positive shut-down due to leala Sensor faifurrJdiscotiaecoon? ❑Ycs; ❑No: <br /> Q 1'cs <br /> _d_N'. For monitoring sya1enl9 shat also serve as tank overfill warning devices, is the overfill warning alarm visible <br /> O N/A and audible at the tank fzU points)and operating properly? if So. U what percent of tank capacity docs the <br /> alarm tai ? <br /> ® yes• Ci No Was any monitoring equipmcci replaced? If yes,identify specific sensors,probes,or other equipment replaced <br /> and list the manufacturer natoc and model for all r '&cement arts in Section E.below. <br /> ❑ No Was an system software upgraded? if yes,idents the new version n-,unbcr in Section E.below. Water. If <br /> Q Yes' Q No Was Iiquid found inside any secondary eontainmcmt systems? (Check all that appf))O Product; O <br /> yes describe causes in Section E.below. <br /> • In Section E below,describe how&tad when these deficiencies were or will be corrected- <br /> E. Comments: <br /> Page 3 of this Ccr[Illcatlotn must be complettd and attached only if one or more of the following condltioas are met: 1.) In- <br /> tank gauging equipment is used to perform leak detection monitoring; 2.)Line leak detrctors are installed on piping system: <br /> 3,)Completion is required by your ioeat agency that regulates UST systems_ <br /> CALyi-01 <br /> Page 2 <br /> � 'd <br /> 2-�,E919�,602 ouI sjoloeuquo0 AI a4113 eLS =80 20 01 400 <br />