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i LIQUID SENSOR FUNCTIONALITY TESTING Faci - Facility Name: Owner. Address: Address: CL City,State,Zip Code: City,State,Zip Code: d Facility I.D.#: Phone#: 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 PEVRP1200 Section 8.3 for the test procedure. Sensor Location ' Product Stored a El Discriminating ❑Discriminating ❑Discriminating ❑Discriminating ❑biscriminating ❑Discriminating ❑Discriminating m Type of Sensor ❑Non-discrimi- ElNon-discrimi- ❑Non-discrimi- ❑Non-discrimi- C1Non-discrimi ❑Nondiscrimi- El Non dlscrimi- a nating nating hating nating nating hating nating g 11Water ElWater ❑Water ❑Water 11Water F-1Water11Water o Test Liquid CJProduct ❑Product ElProduct EIProduct ❑Product ❑Product 11Product v Is the ATG console clear of any active 0 or recurring warnings or alarms < 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, indicate why. 0 Is the sensor alarm circuit []Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No []Yes ElNo operational? R Has sensor been inspected and in ❑Yes 0 N El Yes 0 N ❑Yes ❑No ❑Yes []No ❑Yes El No []Yes El No []Yes 11 No good operating condition? a When placed in the test liquid,does ❑Yes El No []Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes [I No ❑Yes ❑No 0 the sensor trigger an alarm? a When an alarm is triggered,is the --a�l sensor property identified on the ATG El Yes ❑No ❑Yes []No ❑Yes ❑No []Yes ❑No [--]Yes ❑No ❑Yes ❑No ❑Yes ❑No 0 console? of S' Any"No"answers indicates the sensor fails the test. 3 Test Results ❑Pass El Fail ❑Pass ❑Fail ❑Pass ❑Fail El Pass 17-1Fail El Pass ❑fall ❑Pass ❑Fail ❑Pass ❑Fail M c_ Comments: D M. c v � U2 a® Tester's Name(print) Tester's Signature