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C <br />Monitoring System Certification <br />Software Version installed: <br />L <br />complete the following <br />checklist: <br />Is the audible alarm o rational? <br />No* <br />Is the visual alarm o rational? <br />KYesNo* <br />No* <br />Were all sensors visual) ins functional) tested, and confirmed o rational? <br />and so that other equipment will <br />No* <br />Were all sensors installed at lowest point of secondary containment positioned <br />® Yes O No* <br />not interfere with their proper o ration? <br />If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) <br />O N/A <br />operational? <br />OYes O 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) O Sump/Trench Sensors; O Dispenser Containment Sensors. <br />Did you.confirm 2ositive shut -down due to leaks Lnd sensor failure/disconnection? (3 Yes; O No. <br />®Yes O No* <br />For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no <br />O N/A <br />mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank <br />filloint s and operating ro If so, at what,pgrcent of tank capacity does the alarm tri er? % <br />If identify specific sensors, probes, or other equipment replaced <br />O Yes* ® No <br />Was any monitoring equipment replaced? yes, <br />and list the manufacturer name and model for all re iacement parts in Section E. below. <br />OYes* ® No <br />Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) <br />O Product; O Water. If yes, describe causes in Section E, below. <br />® Yes ®No* <br />Was monitorin s stem set -u reviewed to ensure ro er settin ? Attach set u re orfs if a livable <br />® yes Cl No* <br />Is all monitoring uipment o rationalmanufacturer's s ificationO <br />..:11 L.- ®..&-A <br />* iln Section E below, describe how and when [nese aerxreacles wor® V9 w,... `v.. �. •ra <br />UN -036 - 2/4 Page 2 of 4 Rev. 06/04101 <br />www.anidomore <br />