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r , *ECEIVED <br /> D. Results(if'Testing/Servicing MAY 2 3 2013 <br /> Scrflw,are Version Installed: 333.03 <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> Complete the folloin g checklist. <br /> } ® Yes { 0 'No* Is the audible alarm operational`' <br /> ® Yes 0 No* is the visual alarm operational? <br /> }} Oyes G No* Were all sensors visually inspected. Functionally tested.and confirmed opera ional? <br /> it ® Yes 17 No" VVere all sensors installed at JoNvest point ofsecondary containment and positioned so that other equipment will <br /> _ not interfere with their proper operation" <br /> * Yep_ �D No" lt' aurins are relayed to a remote monitoring station, is all communications equipment modem) <br /> 0 1 A o1wrational? <br /> * Yes d Nwl For pressurized piping systema, does the turbine automatically shut down i the piping,secondary containment <br /> G N A monitoring system detects a leak.fails to operate, or is electrically disconne led? irves: which sensors initiate <br /> } positive shut-down? (Check all Thal cqy?? v1 ®Stnnp%Trench Sensors: ® tai..penser Contiimnent Sensors, <br /> Did you confirm positive strut-dpwn ctuc to leaks and sensor failure%disconne tion`? 0 Yes. Q No, <br /> ® Yes 0 No" I-or tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no <br /> F1 N A mechanical overfill prevention valve is installed). is the overfill warning ahirm visible and audible at the tank <br /> fill point(s)and operating,properly." tt"so.at what percent of oink capac:it} does the alarm trier? 40"b <br /> (I Yes* la No Was any monitoring equipment replaced'? if yes, identity specific sensors,probes.or other equipment replaced <br /> and list the manufacturer name and model for all replacement parts in Sectioii E.below. <br /> 1] Yes' Axl No Was liquid Found inside any secondary containment systems designed as dry sv'stems" (C heCk Off 1/1(11 C'm4l!) <br /> 0 Product; ❑Water, Yves.describe causes in Section E.below. <br /> 0 Y,s p No Was monitoring,system set-up reviewed o ensure proper settings?Attach set up repotis, it"applicable <br /> r Yes 0 NOL I,.all monitoring ectuiptnent operational per manufacturer's specifications? <br /> ,in Section k: belim,describe how and when these deficiencies were oi-will be corrected. _ <br /> E. Comnients:TE5T AFTER COLI)START <br /> Monitoring C crtification'hest Report <br /> of 4 <br />