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11111. GV GtJ ✓Jl �1,• �1- <br />Site Address: <br />E <br />D. Results of Testiug/Servicing <br />Software Version Installed: 0 <br />I . U_ <br />I <br />Dace of Testing/Servicing: % <br />DRAFT:' <br />Com lete <br />the foUowing <br />cbecklist: <br />es <br />❑ No, <br />Is the audible alarm operational? <br />es <br />❑ No*" <br />Is the visual alarm operational? <br />es <br />O No* ` <br />Were all sensors visually inspected, functionally tested, and confirmed operational? <br />Yes <br />0 No* <br />Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will <br />not interfere with their proper operation? <br />'es <br />❑ No* <br />If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modirn) <br />❑ N/A <br />Operational? <br />.01-Ycs <br />D No* <br />For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment <br />Q NIA <br />monitoring system detects a leak, fails to operate, oT is electrically disconnected? If yes: which sensors initiate <br />positive shut -down?. (Check all that appl)�Iwnp/Trench Sensors;.[ -Dispenser Containment Sensors. <br />Did you confirm positive shut -down due to leaks and sensor failure/disconnection? ❑ Yes; ❑ No. <br />Q Yes 1 <br />❑ NO* <br />For tank systems that utilize the monitoring system as the primary tank overfill warning device (Le. no <br />,S'`N/A <br />mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank, <br />fill point(s) and operating pro crly? If so, at what percent of tank capacity docs the alarm trigger? <br />Yes* <br />Q No <br />Was any monitoring equipment replaeeW If yes, Identify specific sensors, probes, or other equipmrnt replaced <br />and list the manufacturer name and model for all replacement parts in Section E, below. <br />❑ Yes* <br />Arj4o ' <br />Was liquid found inside any secondary containment systems designed as dry systems? (Check all that app lti) <br />O product; ❑ Water. If yes, describe causes in Section E, below. <br />201�C_3 <br />Q No* <br />Was monitoring system set-up reviewed to ensure proper settings? <br />es <br />U'"No*" <br />Is all monitoring equipment operational per manufacturer's specifications? <br />'. In Section <br />Ili below, <br />describe how and when these deficiencies were or will be corrected. <br />E, Comments: C h a, . "c C, / Z�__ 4 / 0//_ -,�ec -c.,— %Z 01 7 Cl <br />CALM -01 Page 2 of 3 lilts/" <br />