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r monitoring System Certification <br /> Site Address: Date of Testing/Servicing: <br /> D. Results of Testing(Servicing <br /> Software'Version Installed- <br /> Com lete the following checklist: <br /> Yes ❑ No* Is the audible alarm Operational? <br /> Yes ❑ No* Is the visual alarm operational? <br /> es ❑ No* Were all sensorsvisually teal 'onallv tested,and confmned operationg? <br /> V,KYes ❑ No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment <br /> will not interfere with their operation? <br /> ❑ Yrs ❑ No* If Amns are relayed to a remote monitoring station, is an c�naaaars€aic ations equip (e_g ) <br /> W141A operational? <br /> Yes ❑ No* For pressurized Piping systems,does the turbine automatically shirt down if'thein <br /> piP g secondary contmnment <br /> ❑ N/A monitoring system detects a leak, fails to operate, or is electrically disconnecters? If yes: which sensors <br /> initiate positive shut-down? (Check all that apply) '%?§umpffreach Sensors; ❑ Dispenser Containment <br /> Sensors. <br /> Did You cm&m positive shirt-dowry due to leaks d r ection? [R,-yes; ❑No. <br /> ® Yes ❑ No* For tank systems that utilize the monitoring system as the prim tank overM warning device (i e <br /> E`EN/A mechanical overfill Prevention valve is ' ed).is the ov g alarm aisibIe and audible at the <br /> tank <br /> M int(s)and operating promLly? If so,at what percent of tank capacitv does the <br /> ❑ Yes* No Was any monitoring equipment replaced? l£ yes, identify specific sensors, p or other equipmentre laced and list the of r and <br /> model for all replacement <br /> F,below. <br /> es* i 1 No Was liquid found inside any secondary eng' de&Lgned as dry _ ? (Ckecsr aU.tom apply) <br /> M-Pact ❑Water. if yes, in 5 €lorr lr,low. <br /> ❑ Yes ❑ No* Was rnonatorin ern set reviewed to ensure propersettings? <br /> ❑ Yes J ❑ No* Is ail monitoring qgui It OPerational per manufacturer-,s cations? <br /> In Section E below,describe how and when these deficiencies were or will be corrected. <br /> E. Comments: 14// ii ��''/ il�.•S trtf� �/2 d' y� Si GYM' �/�L�cnl <br /> dam- �-x�•� ®E/�;/' <br />