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I LIQUID /D 0 0 Facility Name: Owner: Address: Address: n- CLm City,State,Zip Code: City,State,Zip Code: Facility I.D.#: Phone#: r Testing Company: Phone#: Date: o This procedure is to determine whether liquid sensors located in the interstitial space of UST systems are able to detect the presence of water and fuel.See PEVRP1200eD ! Section 8.3 for the test procedure. , i Sensor LocationUnCU' Product Stored C CL ❑Discriminating 11 Discriminating ❑Discriminating ❑Discriminating ❑Discriminating [:]Discriminating 11 Discriminating m Type of Sensor ❑Non-discrimi- ❑Non-discrimi- ❑Non-discrimi- ❑Non-discrimi- ❑Non-discrimi- ❑Non-discrimi- ❑Non-discrimi- nating nating nating nating nating nating nating o i Test Liquid ❑Water ❑Water ❑Water ❑Water ❑Water ❑Water ❑Water 0 ❑Product ❑Product ❑Product ❑Product ❑Product ❑Product ❑Product -o Is the ATG console clear of any active o or recurring warnings or alarms C regarding the leak sensor?If the ❑Yes ❑No ❑Yes ❑No []Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes []No sensor is in alarm and functioning, rE aj indicate why. + 0 1 Is the sensor alarm circuit ❑Yes ❑No []Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No []Yes ❑No CD operational? o• Has sensor been inspected and in ❑Yes ❑No []Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No []Yes ❑No good operating condition? Q When placed in the test liquid,does e ❑Yes ❑No ❑Yes El No ❑Yes 11 No []Yes El No ❑Yes 0N ❑Yes []No El Yes 11 No 0 the sensor trigger an alarm? Q v When an alarm is triggered,is the sensor properly identified on the ATG ❑Yes ❑No ❑Yes ❑No []Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No a console? v 5' Any"No"answers indicates the sensor fails the test. m CD Test Results ❑Pass O Fail ❑Pass ❑Fail ❑Pass ❑Faii ❑Pass ❑Fail E Pass ❑Fail ❑Pass ❑Fail ❑Pass ❑Fail c Comments: 3 c C' En Tester's Name(print) Tester's Signature N f I