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6frun-RrAa inti. GR Job# 17203105 <br /> D, Results of Testing/Servicing RECENED <br /> Software Version Installed: 333.05 0 C T 12 2017 <br /> Complete the following checklist: <br /> r es ® o Is the audible alarm operational? <br /> Yes ® No' Is the visual alarm operational? <br /> 11 Yes [3 No` Were all sensors visually inspected,functionally tested,and confirmed operational? OEFDARTMEHT <br /> jj Yes 13 No' Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their <br /> proper operation? <br /> [Z Yes ❑ No" Nalarms are relayed to a remote monitoring station,is all communication equipment(e.g.modem)operational? <br /> ® NIA <br /> ff Yes ® No* For pressurized piping systems,does the turbine automatically shut down if the piping secondary containment monitoring system <br /> N/A detects a leak,fails to operate,or is electrically disconnected?If yes:which sensors initiate positive shut-down?(Check all that apply) <br /> rx Sump/Trench Sensor; 9 Dispenser Containment Sensor.Did you confirm positive shut-down due to leaks and sensor <br /> failureldisconnection? r, Yes; ® No. <br /> 1.3 Yes ® No' For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.no mechanical overfill prevention <br /> ® N/A valve is installed),is the overfill warning alarm visible and audible at the tank fill point(s)and operating properly?If so,at what percent <br /> of tank capacity does the alarm trigger? --20--% <br /> ® Yes No Was any monitoring equipment replaced?If yes,identify specific sensors,probes,or other equipment replaced and list the <br /> manufacturer name and model for all replacement earls in Section E,below. <br /> -6—Yes No Was liquid found Inside any secondary containment systems designed as dry systems?(Check all that apply) []Product; ❑Water. If <br /> yes,describe causes in Section E,below. <br /> Yes ® No*--I Was monitoring system set-up reviewed to insure proper settings?Attach set-up reports,if applicable. <br /> Yes ❑ No' I is all monitoring equipment operational per manufacture's specifications? <br /> In Section E below,describe how and when these deficiencies were or will be corrected. <br /> E. - Comments: <br /> Monitoring System Certification Page 2 of 4 12107 <br /> 3 <br />