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A Results of Testing/Servicing <br />Software Version Installed: 14.04 <br />Complete the followine checklist: <br />® Yes <br />❑ No* <br />I Is the audible alarm operational? <br />® Yes <br />❑ No* <br />Is the visual alarm operational? <br />® Yes <br />❑ No* <br />Were all sensors visually inspected, functionally tested, and confirmed operational? <br />® Yes <br />❑ No* <br />Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will <br />not interfere with their proper operation? <br />❑ Yes <br />❑ No* <br />If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) <br />® N/A <br />operational? <br />For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment <br />® Yes <br />❑ No* <br />monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate <br />❑ N/A <br />positive shut down? (Check all that apply) ® Sump/Trench Sensors; ® Dispenser Containment Sensors. <br />Did you confirm positive shut down due to leaks and sensor failure/disconnection? ® Yes; ❑ No. <br />* <br />For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no <br />El Yes <br />® NSA <br />mechanical overfill prevention valve is installed), is the over -fill warning alarm visible and audible at the tank <br />fillpoint(s) and operating ro erl ? If yes, at what percent of tank capacity does the alarm trigger? % <br />❑ Yes* <br />® No <br />Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced <br />and list the manufacturer name and model for all replacement parts in Section E, below. <br />❑ Yes* <br />® No <br />Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) <br />❑ Product; ❑ Water. If es, describe causes in Section E, below. <br />® Yes <br />❑ No* <br />Was monitoringsystem set-upreviewed to ensure proper settings? Attach set u reports, if applicable <br />® Yes <br />❑ No* <br />Is all monitoring a ui ment operational per manufacturer's specifications? <br />* In Section E below, describe how and when these deficiencies were or will be corrected. <br />E. Comments: <br />Page 2 of 3 <br />Monitoring System Certification <br />