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Monitoring System Certification <br /> Address: 124 W. ELM ST. LODI 95242 Service Date: 12/04/2009 <br /> D. Results of Testing/Servicing <br /> Software Version Installed: 122.00 <br /> Complete the fo owing checklist: <br /> ®Yes ❑No* Is the audible alarm operational? <br /> ®Yes ❑No* Is the visual alarm operational? <br /> ❑Yes ®No* Were all the sensors visually Inspected,functionally tested,and cofirmed operational? <br /> ❑Yes ®No* Were all sensors installed at lowest point of secondary containment and positioned so that other <br /> e ui ment will not interfere with their proper operation? <br /> ®Yes ❑No* If alarms are relayed to a remote monitoring station,is all communications equipment(e.g. modem) <br /> operational? <br /> ❑NIA <br /> ❑Yes ❑No* For pressurized piping systems,does the turbine automatically shut down if the piping secondary <br /> containment monitoring system detects a leak,falls to operate,or is electrically disconnected? <br /> If yes:which sensors <br /> initiate positive shut- ElSump/Trench Sensors El Dispenser Containment Sensors <br /> ®NIA <br /> down?: <br /> Did you confirm positive shut-down due to leaks and sensor failure/disoonnection? ❑yes ❑No <br /> ®Yes p No* For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e. no <br /> mechanical overfill prevention valve is Installed), is the overfill warning alarm visible and audible at the <br /> ❑NIA t°k till point(s)and operating properly?If so,at what percent of tank capacity does the alarm trigger?: <br /> ®Yes* ❑No Was any monitoring equipment replaced?If yes,identify specific sensors, probes,or other equipment <br /> replaced and list the manufacturer name and model for all replacement parts in Section E below. <br /> Was liquid found inside any secondary containment systems designed as dry systems? <br /> El Yes" Z No If yes.check the type(s)of liquid found and describe causes in Section E,below. E)Product El Water <br /> ®Yes ❑No* Was monitoring system set-up reviewed to ensure proper settings?Attach set up reports, if applicable <br /> LN-Yes 0 No* I Is all monitoring equipment operational per manufacturers specifications? <br /> "in Section E below,describe how and when these deficiencies were or will be corrected. <br /> E. Comments <br /> Tank probe Veeder-Root#847390-107 was replaced like for like. <br /> This certification is for the Tank Probe only. No other sensors were inspected or tested at this time. <br /> An Overfill Prevention Valve is installed in the drop tube. <br /> 1 <br /> Monitoring System Certification Page 2 of 4 12107 <br /> 2 2121107 <br />