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REGEIVEL D. Results of Testing/Servicing MAR 11 2016 Software Version Installed 17.01 Comfete the followingchecklist: FN j NTAL ® Yes ❑ No' Is the audible alarm operational? }.!Cnt Ti' rr 1• AArK, ® Yes ❑ No' Is the visual alarm operational? ® Yes ❑ No' Were all sensors visually inspected,functionally tested,and confirmed operational? ® Yes ❑ No' Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? ❑ Yes ❑ No' If alarms are relayed to a remote monitoring station,is all communications equipment(e.g.,modem)operational? ® N/A ® Yes ❑ NW For pressurized piping systems,does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak, ❑ N/A fails to operate,oris electrically disconnected? If yes:which sensors initiate positive shut-down? (Check all that apply) ®Sump/Trench Sensors; ®Dispenser Containment Sensors. Did you confirm positive shutdown due to leaks and sensor failure/disconnection? ®Yes; ❑No. ❑ 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 ® N/A installed),is the overfill warning alar visible and audible at the tank fill point(s)and operating property? If so,at what percent of lank capacity does the alarm trigger? % ❑ ® No Was any monitoring equipment replaced? If yes,identify specific sensors,probes,or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E,below. Yes ❑ ® No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) ❑Product; []Water. If yes,describe causes in Section E,below. Yes ® Yes ❑ No' Was mon tonng system set-up reviewed to ensure proper settings?Attach set up reports,if applicable ® Yes 10 No' Is all monitoring equipment operational per manufacturers specifications? In Section E below,describe how and when these deficiencies were or will be corrected. E. Comments: Monitoring System Certification Page 2 of 4 2/21/07