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1�1 <br />Monitoring System Certification - Page 2 of 3 <br />E <br />Site Address: 35 N. Cherokee Ln. Date of Testing/Servicing: 1/28114 <br />D. Results of Testing / Servicing <br />Sofhvare Version Installed 122.00 <br />Comnlete the following checklist: <br />0 Yes <br />❑ No* <br />Is the audible alarm operational? <br />a Yes <br />❑ No* <br />Is the visual alarm operational? <br />is Yes <br />❑ No* <br />Were all sensors visually inspected, functionally tested, and confirmed o2erational? <br />6 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 />a Yes <br />❑ No* <br />If alarms are relayed to a remote monitoring station, is all communications equipment (e,g. modern) <br />❑ N/A <br />operational? <br />a Yes <br />❑ No* <br />For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment <br />❑ N/A <br />monitoring system detects a leak', fails to operate, or is electrically disconnected? If yes: which sensors initiate <br />positive shut -down? (Check all that apply) n Sump/Trench Sensors; ❑ Dispenser Containment Sensors. <br />Did you confirm positive shut -down due to leaks and sensor failure/disconnection? N Yes ❑ No <br />❑ No* <br />For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no <br />IS N/A <br />mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank <br />fill points) and operating properly? If so, at what percent of tank capacity does the alarm trigger? 0 % <br />❑ Yes* <br />N No <br />Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced <br />and list the manufacturer name and model for all replacement parts in Section E, below. <br />0 Yes* <br />❑ No <br />Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) <br />❑ Product; N Water. If yes, describe causes in Section E, below. <br />W Yes <br />❑ No* <br />Was monitoring system set-up reviewed to ensure roper settings? Attach set-ypneearts, -ifapplicable.) <br />M Yes <br />❑ No* <br />Is all monitoring equipment operational per manufacturer's specifications? <br />* In Section E below, describe how and when these deficiencies were or will be corrected. <br />FF:i 27 204 <br />W <br />FW1 il; j <br />=1 I Z1,14 IN 11Z 1111;1* -I V� 14am <br />