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j GEMER-RYAN INC. GR Job # 10-062101.1 <br />D. Results of Testing/Servicing <br />Software Version Installed: <br />Comoiets the foilowtno checklist: <br />333.03 <br />r <br />yes <br />❑ o <br />Is the audible alarm operational? <br />r, <br />Yes <br />❑ No' <br />Is the visual alarm operational? <br />[i <br />Yes <br />❑ No` <br />Were all sensors visually inspected, functionally tested, and confirmed operational? <br />U <br />Yes <br />❑ No` <br />Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their <br />proper o eratlon? <br />❑ <br />Yes <br />❑ No' <br />If alarms are relayed to a remote monitoring station, is all communication equipment (e.g. modem) operational? <br />FL WA <br />rg <br />Yes <br />❑ No' <br />For pressurized piping systems, does the turbine automatically shut down If the piping secondary containment monitoring system <br />❑ N/A <br />detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors Initiate positive shut -down? (Check all that apply) <br />ra Sump/Trench Sensor, 9 Dispenser Containment Sensor. Did you confirm positive shut -down due to leaks am sensor <br />failure/disconnection? (g Yes; ❑ No. <br />jj <br />Yes <br />❑ No' <br />For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no mechanical overfill prevention <br />(3 N/A <br />valve is installed), is the overfill warning alarm visible and audible at the tank fill points) and operating properly? If so, at what percent <br />of tank capacity does the alarm trigged --LO--% <br />[j <br />Yes <br />❑ No <br />Was any monitoring equipment replaced? If yes, Identify specific sensors, pros, or other equipment replaced and list the <br />manufacturer name and model for all replacement parts in Section E, below. <br />❑ <br />Yes <br />ra No <br />Was liquid found Inside any secondary containment systems designed as dry systems? (Check all that apply) []Product; ❑Water. If <br />yes, describe causes in Section E, below. <br />IL- <br />Yes <br />❑ No' <br />Was monitoring system set-up reviewed to insure proper settings? Attach set-up reports, K applicable. <br />Ej <br />Yes <br />113 No' <br />Is all monitoring equipment operational per manufacture's specifications? <br />f 1.. C�-u�� G L.1.... <br />J-��dL.. L..... ....d ...L� .L�-.. J..Y�I....�1.... ...........�..dll Lo ..........MJ <br />E. Comments: <br />Monitoring System Certification <br />Page 2 of 4 <br />0 <br />12107 <br />