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Jan 10 03 02:22p Ca rie Brown (20 461-6342 p.3 <br />PAGE 82 <br />ENV. HEALW <br />01/02/1995 03:27 2097546722 pia' <br />1%imitoring System Certification <br />Facility Name:_�✓ ,n ! sit t j�J�G / W. is of icsnag,acrvicros: <br />ry e y <br />D. Results of TestinWServicing <br />r-.,,....s.to etv fntlowinr checklist: <br />Iff-Yes <br />sill Yes <br />Q No, <br />® Na- <br />® No- <br />® Nov <br />Is the momito s stent operational rnatcufactvSez's s catacanons c <br />Is the audible alarm o banal? <br />is the viausl alarm operational? <br />were all seasons Viso ins teste and confxxxied o Boman? <br />go Yes <br />e Yes <br />(a Yes <br />13 No* <br />We= all sensors sad robes remstailed r cel ? <br />Yes <br />Cl No" <br />Is all monitor:n c :u saettt secured from unauthorized tint ? <br />is all communications equipment (e.g. rpodcm) <br />0 Yes <br />® No" <br />if alarms are relayed to a remote mooitonzng station, <br />C) Yes <br />IV NIA <br />tial No" <br />if needed by any monitoring equipment, arc repwcmcut fivas an&or batteries available? <br />yes <br />(r DVA <br />Q 1Eo+ <br />For pressunred piping systems, does the turbine automatically shut down if the Pipintg sccon�. t oataaarttestt <br />disconnected? if which scissors inatiate <br />Q NIA <br />monitoring system detects a teak fails to operate, or is electrically yes: <br />Q Su='PrTre nth Sc0sm; 0 Dispenser Containment Scnsoa- <br />positive shut -down? (Cheek all that apply) <br />Did confirm shut -down due to leaks id sensor fAih1T /diseOmuecUOn? Li Yes: 0 No. <br />Q Yes <br />Q No' <br />you positive <br />Fos tnonewmg systems that also serve as tank ovetftli warmiDg devices, is the overfill wtuning alum visible <br />If what of tu* capacity does. the <br />01 NIA <br />and audible at the tank fn point(s) and operating properly? so, at percent <br />Cl Yes* <br />AD No <br />alum -trigger? °l• <br />Was any monitoring equipment replaced? If yes, identify specific sensors, probes. or other equipment replaced <br />and Inst the manufacturer name and model for all r lacement fou in Secnota $ below. <br />Yes <br />iii No <br />Was !nj SYS= software upgraded? If yes, identify the new version number in Section F- below. <br />Check all char aFFIY) O Product; ®Water- if <br />(j Yes- <br />CAla <br />Was liquid found inside any secondary contaimmcat systems? <br />describe causes in -Section E. below. <br />r� <br />i4 Ina Section JE bolo . dt%CnOe ROW man w8cc11 ancac ucuds.:.aa — ...., ....e -,. - <br />Page 3 of this Certification trust be completed and attached only if one or more of the following conditianas are fact: 1.) fa - <br />tank ganging equipment Et used to perforin leak detection monitoring; 2.) line Itak detectors are installed on pip#atg systems: <br />3.) Cecrcgtetialo is rcqurred loy your local agency that rogWates USF systems. <br />CALM -or Page 2 t+ ZY" <br />