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JAN-20-2012 11:08 Service Station Systems 408 938 8888 P.04 <br /> 40 0 <br /> Monitoring System Certification-Page 2 of 3 <br /> Site Address: 3725 N.Tracy Blvd. bate of Testing/Servicing: 1/5/12 <br /> D. Results of Testing/Servicing <br /> Software Version installed-._127.04 <br /> Comlate the followin checklist: <br /> a Yes ❑ No* Is the audible alarm operational? <br /> 0 Yes ❑ No* I's the visual alarm operational'? <br /> ® Yes C1 No* Were all sensors visually inspected,functionally tested,and confirmed operational'? <br /> ® Yes ❑ No* 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 ❑ No* if alarms are relayed to a remote monitoring station,is all communications equipment(e.g. modem) <br /> 0 N/A operational? <br /> 19 Yes Q No* For pressurized piping systems,does the turbine automatically shut down if the piping secondary containment <br /> ❑ N/A 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) ® Sump/Trench Sensors; ❑ Dispenser Containment Sensors, <br /> Didyou confirm positive shut-down due to leaks and sensor failure/disconnection? ® Yes © No <br /> ❑ Yes ❑ No* For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.no <br /> H N/A mechanical overfill prevention valve is installed),is the overfill warning alarm visible and audible at the tank <br /> fill pints and o crating ro era ? if so,at whatpercent of tank ca aciEy does the alarm n i ger? Q %, <br /> ❑ Yes* N No 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 re lacement 2arts.in Section E,below. <br /> 13 Yes* N No Was liquid found inside any secondary containment systems designed as dry systems? (Cheek all that cy)ply) <br /> ❑ Product;❑ Water. If Xcs,describe causes in Section E,below. <br /> 0 Yes ❑ No* Was monitoring system set-tip reviewed to ensure proper settings'? Attach set-u�reports, i a licable. <br /> 0 Yes ❑ No* Is all monitoring equipment operational per manufacturer's srecifications? <br /> *In Section E below,describe how and when these deficiencies were or will be corrected. <br /> E, Comments: <br />