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i LIQUID •- FUNCTIONALITY TESTINGI � 0 3 Facility Name: Owner. 3 M Address: Address: CL City,State,Zip Code: City,State,Zip Code: : I 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 PEI/RP1200 Section 8.3 for the test procedure. Sensor Location Product Stored a i ❑Discriminating 11 Discriminating ❑Discriminating El Discriminating ❑Discriminating ❑Discriminating 11 Discriminating Type of Sensor ❑Non-discrimi- ❑Non-discrimi- ❑Non-discrimi- ❑Non-discrimi- ❑Non-discrimi- ❑Non-dfscrimi- ❑Non-discrimi- nating nating nating nating nating nating nating o 0 Test Liquid ❑Water ❑Water ❑Water ❑Water ❑Water ❑Water ❑Water N ❑Product ❑Product ❑Product ❑Product ❑Product ❑Product ❑Product -o Is the ATG console clear of any active 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 ❑No operational? �. I � Has sensor been inspected and in ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No []Yes ❑No O good operating condition? a When placed in the test liquid,does ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No []Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No 0 the sensor trigger an alarm? a 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 0 console? 5' Any"No"answers indicates the sensor fails the test. B Test Results []Pass ❑Fail ❑Pass ❑Fail ❑Pass ❑Fafl ❑Pass ❑Fail ❑Pass ❑Fall ❑Pass ❑Fall ❑Pass ❑Fail n c Comments: "o a M. c o � to ® Tester's Name(print) Tester's Signature N I