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Nov 1.8 11 08:55a Elite IV Contactors 12094616342 p.4 <br />Mai 15 09 12:53p E& iv Contractors Inc 20546 42 p.3 - <br />Facility N...: (T sa s, <br />Y L}. Rtxltlls of TCitln�(SerYscing <br />Com acre the fcofiovt4ag chct:klisl:- <br />yes <br />C1 No- <br />I Is the rnontm=rrsystem opcj2i6oral per mauu(acwrcr`5 S cificaiiaias'! _ <br />1'.i' Ycs <br />0 No* <br />Is the rirdible alarm o donai? <br />Yes0 <br />0 Nilo' <br />is the viucaf alarm „�ecrpersttoalS? a �_ <br />Yes <br />Q No* <br />were all s visut me ird. trsmi, tmd Cnafiruird o;ieratiouttt: <br />.Irk Yes <br />CI No, <br />Wcm &U sca rs and rot,e_. reiast4ed r icti ? <br />41 Yis <br />0 No. <br />is 111 morutorm Bili ar seemed from umulhoriz-cd t ttti ? <br />WYC4 <br />Q No- <br />if m):A s dere mlayt:'d to a rtmotC =Uiromf statim ir, all come. E14c1tions equittil7_^nr (e.g. mrutcaij <br />a NIA <br />cYpeca60081? -- <br />D Yes J <br />C_1 No <br />ff needed by nay r mnoonng egaipmemt, ate rcplrccmant fuses aiidtor 1 tit !tics aval4ble? <br />Yes <br />T A <br />U No® <br />For pimssurixtd prptnt;, systean, does the sorbin: automatically sber d•ru if the gigui�; sccohitaiy cpniiitirnenl <br />L-2 N/A <br />ytaatiita r,g sxstcm detects it ftak fails to operntc, at is r:lectaeally dist:ar m%cd? If Yes: which sensors radiata <br />posinv,c shut -down? (Check aft char gFAly) CI SttaigtTreacit semors; C Dispenser Contamneent SC=O;%_ <br />Did you coatPum positive gb ur-down dna to lea8s W .caws fatlurmtdiS:O Mclion? ❑ Yes; D No - <br />Yes <br />0 No- <br />For nwmkorin% %yttt= that also sctvt its %mmk oaerfiil wamiag devir,= iS itm avcr{ifl wucrlin8 MUM visiak <br />Ct NIA <br />nad audible at the tank fill points? and aperarLag prvperiy' If so, aC w i;t percent of oak capscity docs ibc <br />Allum air <br />Yes* <br />NO <br />Was say mcaitosmg equipment ieplaccdf? If yes, idcdttfy .%p='fic sem. sr iirobcs, oc other egaipmew replaced <br />+ <br />rad list cite maon:Facsa=rmaroeand model for &.111T1%0=cnt rafts in Sec usa 1~, below. <br />C1 Ycs` rA No Wats ligwd foumd tmside any sc <br />yen, dmribc cans" in Section <br />In Seerton JE betnw, de:ccibe how and when lucre <br />led? If yes, tdend the new verrsion n'Gxr rr in Se Balt F. belnur. <br />ond=y cautam7=up sySicws? (Chock.:d 5'sar gppty) Cl Prodmet; O WaICT. If <br />were or +mill be Correetett <br />Page 3 of this C'ertMcmtion must be completed a&4 artubed only if one of snore of the fill Wrrgrr Coodkiova are inct l,) In - <br />tank gituring egmr pment fx Used to perform Imm dctei:tion moatitortng. 2.j Line teak dcgee"o ; Butt injamUcd on pl{rtag ryttems: <br />3,) CtiKUPIetio- .x rcgsitcvd lir your fogad agency that rOCUUtes, UST axkeeccec. <br />CAjUW- tt <br />pRxe 7 <br />