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U C.' Certification - I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturerspec ist)gecessary to verify that this information is correct and a Plot Plan showingthe layout of monitoring equipment. For an , e ue ry y gQ Qt-'Eapable of generating such reports, I have also attaclipd a copy of the repo ; (check alt that apply): stem s �'m history report Technician Name (print): =,�%s�� r r,e -: q Signature: Certification No.: �� License. No.: Testing Company Nam'e Phone o Date o f Testing/Servicing: ,n� / Servic-, in�g. ' DSite Address w / _ /� U Monitoring System Certification Page I of 3 D. Results of Testing/Servicing Software Version Installed: Camnlete the fnlanwina ehaMlr®ict• 03/01 es ❑ No* I Is the audible alarm o rational? V—Yes ❑ No* I Is the visual alarm o rational? R—Yes ❑ No* Were all sensors visually inspEYA functionally tesLed, and confirmed operational? Yes ❑ No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with theiEpLo22r operation? ❑ Yes ❑ No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) IR�V/A operational? OL,Yes ❑ No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment ❑ N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut -down? (Check all that apply) ump/Trench Sensors; ispenser Containment Sensors. Did you confirm positive shut -down due to leaks Wd sensor failure/disconnection? es; ❑ No. es ❑ No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no ❑ N/A mechanical overfill prevention valve. is installed), is the overfill warning alarm visible and audible at the tank fill in s and operating ro rl If so at what rcent of tank does the alarm tri er? es* ❑ No Was any monitoring equipment replaced? , If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all lacement in Section E below. ❑ Yes* o Was liquid found inside any secondary; containment systems designed as dry systems? (Check all that apply) ❑ Produ ❑ Water. If es describe causes in Section below. V -Yes ❑ No* Was monito ' set reviewed to ensure m settings? Attach set its if applicable ❑ No* Is all monitorin equipmento rational per manufacturer's specifications? * In Section E below, describe how and when these deficiencies were or will be corrected. E Comments: D....,. '1 ^r 1