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Aug. 18. 2016 10: 19AM, Do I ee Pump Co No, 5143 P. 4 <br /> Monitoring System certification <br /> A Results of Testing/Servicing <br /> AUG <br /> Software Version Installed: <br /> est - <br /> Co lets the followving checklist; <br /> l 'Yes 0 No* Is the audible alarm operational? <br /> 9)* 0 No* Is the visual alarm operational? <br /> grks' 0 14o* Were all sensors visually inspected,functionally tested,and confirmed operational? <br /> WYes, 0 NO Were all sefisors installed at lowest point of secondary containment and positioned so that other equipment will <br /> not interfere with their proper operation? <br /> Yes 0 No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g., modem) <br /> 0 N/A operational? <br /> Yes [I NO For pressurized piping systems,does the turbine automatically shut down if the piping secondary containment <br /> [3 N/A monitoring system detects leak,fails to operate,or is electrically disconnected? if yes;-which sensors initiate <br /> positive shut-down? (Check all that apply) [3 Sumpffrench Sensors; Ll I)ispenser Containment Sensors. <br /> Did you confirm positive shut-down due,to leaks and sensor failure/disconnection? 0 Yes; 0 No. <br /> Yes [j No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no <br /> [I N/A.,' mechanical overfill prevention valve is installed), is the overfill warning alum visible and audible at the tank <br /> 7 fill point(s)and operating properly? If so,at what percent of tank capacity does the alarm trigger? % <br /> 0 Yes- No Was any monitoring equipment replaced? If yes,identify specific sensors,probes,or other equipment replaced <br /> and list the manufacturer name and model for all replacement parts in Section E,below. <br /> EFYes* (I No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) <br /> 0 Product; 0 Water. If yes,describe causes in Section E,below. <br /> E(y!!s 1 [3 NO I Was monitoring system set-up reviewed to ensure proper settings?Attach set up reports,if applicable <br /> WYes 1 [3 NO Is all monitoring equipment operational per manufacturer's specifications? <br /> In Section E below,describe how and when these deficiencies were or will be corrected. <br /> E. Commeats: <br /> ke, taM f kad Y" <br /> UN-036-3/6 www.unidocs.org Rev.01111108 <br />