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Monitoring System Certification <br />Site Address: <br />D. Results of Testing/Servicing <br />Software Version Installed: <br />Gomnlete`the following checklist: <br />Date of Testing/Servicing: <br />Yes <br />❑ No*Is <br />the audible alarm operational? <br />UL Yes <br />❑ No* <br />Is the visual alarm operational? <br />3,Yes <br />❑ No* <br />Were all sensors visually inspected, functionally tested, and confirmed operational? <br />.Yes <br />❑ 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 />❑ Yes <br />❑ No* <br />If alarms are relayed to a remote monitoring station, is all communications equipment (e g.'modem)' <br />P(N/A <br />operational? <br />❑ Yes <br />❑ No* <br />For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment` <br />AN/A <br />monitoring system detects a leak, tails to operate, or is electrically disconnected? If yes: -which sensors initiate <br />positive shut -down? (('heck all that a/7/7I0 ❑ Sump/Trench Sensors; ❑ Dispenser Containment Sensors. <br />Did you confirm positive shut -down due to leaks and sensor failure/disconnection? ❑ Yes,; ❑ No. <br />❑ Yes <br />❑ No* <br />For tank systems that utilize the monitoring system as the primary tank overfill warning d®vtC6�.ie no <br />N/A <br />mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible st <br />fill point(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? <br />O Yes* <br />9_No <br />Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipments laced :i <br />and list the manufacturer name and model for all replacement parts in Section E, below. <br />❑ Yes* <br />No <br />Was liquid found inside any secondary containment systems designed as dry systems? (Check 611 t reply) <br />.i1 <br />❑ Product; ❑ Water. If yes, describe causes in Section E, below. <br />Yes <br />❑ No* <br />Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable ` <br />Yes <br />❑ No* <br />Is all monitoring equipment operational per manufacturer's specifications? <br />* In Section E below, describe now and wnen tnese denc'enc'es were or will ue correcteu. <br />E. Comments: AJoi��___ •w r- �� _— ('� �,� 1 "i"5 F' 1 S S 7" <br />AS ri" rv+cs to <br />