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Monitoring System Certification <br /> Site Address: Cf 5a LO, ( � ��Cc C u Date of TestingiServicing: ?0—y — s <br /> D. Results of Testing/Servicing <br /> Software Version Installed: <br /> Comoicte the following checklist: <br /> eYA ❑ No* Is the audible alarmoperational? <br /> es ❑ No* Is the visual alarm rational? <br /> ® No* Were all sensors visually inspected, onally tested,and confirmed operational? <br /> Yes ❑ No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment <br /> will not interfere with their ffopE operation? <br /> ❑ Yes ❑ * If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) <br /> N/A operational?' <br /> Yes ❑ No* For pressurized piping systems,does the turbine automatically shut down if the piping secondary containment <br /> ❑ N/A momtonng system detects a leak, fails to operate, or is elecirmally disconnected? yes: which sensors <br /> positiveinitiate shut-down? (Check all that apply) umplTrench Sensors; Ef5ispenser Containment <br /> Sensors. <br /> Did you confirm positive shut-down due to leaks and sensor failurefdisconnecuon? p'Ye , ❑No. <br /> Yes ❑ No* For tank system that utilize the monffonng system as the prunary tank overfill warning de-ace (Le. no <br /> ❑ N/A mechanical overfill prevention valve is ' ed), as the overfill warning alarm visible and audible at the tank <br /> fillpoint(s) T ? If so,at what of tank capacity does the alarm trigger? TMI/o`fir <br /> ❑ Yes* No Was any monitoring equipment replaced? If yes, identify sensors, probes, or other equipment <br /> x replaced and list the manuthcturer name and model for all replacement in Section E, below. <br /> ❑ No Was liquid found inside any secondary containment systems as dry systems? (Check all that apply) <br /> ❑ • ❑Water. If Les,describe causes in Section E, bei <br /> 9YYes ❑ No* Was moni set-up reviewed to ensure pr2per in ? <br /> PI-Yes ❑ No* Is all monita ' ST#pmento ratio r acturer'scations? <br /> *3n Section E blow,describe how and when these deficiencies were or wiH be corrected- <br /> F. Comments: �/1`` 1jq-ru IN, g7 S"r- <br />