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04/16/2004 10:59 1209365 TANKNOLOGY PAGE 07 <br /> Monitoring System Certification <br /> Site Address; 290.5 W. BENJAMIN HOLT Date of Tarting/Servige; 03L29J2904 <br /> a 1-6 <br /> D. Results of Testing/Servicing <br /> Software Version installed; 120.02 <br /> Complete the following checkli%t: <br /> JL Yes _0 No. Is the audible alarm operational? <br /> _My" Ll No. Is the visual alarm operational? <br /> -My" 1:1 No' Were all sensors visually inspected,functionally tested,and confirmed operational? <br /> W7 - <br /> El Yes Ll N.- <br /> Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not <br /> interfere with their proper operation? <br /> 771 Yes L]No' r7 NIA if alarms are relayed to a remote rnQnRoring station,is all communications equipment(e.g.modem)operational? <br /> For pressurized 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,of Is electrically disconnected?if yes;which sensors initiate positive <br /> shut-down?(check all that apply) ED Sump/Trench Sensors; El Dispenser Containment Sensors, <br /> Did you confirm positive shut-down due to looks and sensor fallura/disopnnection? [M ym []No <br /> Yes No- NIA <br /> For tank systems that utilize the monitoring system as the primary tank overfill warning device(Le,:no mechanical <br /> overfill prevention valve is installed),Is the overfill warning alarm visible and audible at the tank fill points(s)and operating <br /> properly? If so,At what percent of tank capacity does the alarm trigger? <br /> Yes" No Was any monitoring equipment replaced?If yes,identify specIfitc-w, -,a -and-Hm the <br /> manufacturer name and model for all replacement parts in Section E.below. <br /> E] Yes' No Was liquid found inside any secondary containment systems designed as dry systems?(check all that apply) Product: <br /> 0 Water. If yes,describe causes In Section E,below. <br /> [EX Yes No Was monitoring system set-up reviewed to ensure proper settings?Attach set-up reports.If applicable. <br /> L <br /> P:Y-: No. Is all monitoring equipment operational per manufacturers'specifications? <br /> In Section E below,describe how and when these deficionces were or will be corrected, <br /> E. Comments: <br /> Page 2 of,3 Based on CA form dated 03101 <br />