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Monitoring System Certification D. Results of Testing/Servicing Software Version Installed: ��• �Z Complete the following checklist: Yes ❑ No* Is the audible alarm operational? Yes ❑ No* Is the visual alarm operational? 151,Yes (3 No* Were all sensors visually inspected,functionally tested,and confirmed operational? Yes ❑ No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? ❑ Yes ❑ No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) .W N/A operational? ❑ Yes ❑ No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment ❑ NIA monitoring system detects a leak, fails to operate,or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check all that apply) ❑ Sump/Trench Sensors; ❑ Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ❑Yes; ❑No. ❑ Yes ❑ No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no ❑ N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill oint s and operating ro erl ? If so,at what percent of tank capacity does the alarm trigger? _go % ❑ Yes* I3 No Was any monitoring equipment replaced? If yes,identify specific sensors,probes,or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E,below. ❑ Yes* IA No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) ❑ Product ❑ Water. If yes,describe causes in Section E,below. $1 Yes ❑ No* Was monitoring system set-vreviewed to ensure proper settings?Attach set up reports, if applicable Yes I ❑ No* Is all monitoring equipment oerational per manufacturer's specifications? * In Section E below,describe how and when these deficiencies were or will be corrected. E. Comments- / n1I 11 ) CQAJ T e <T Y7 1 A n 46D, =_t1#._1 UN-036-2/4 Page 2 of 3 Rev.06/03/01 rvwmunidoes.org