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41onitoring System Certification <br /> Site Address 2725 COUNTRY CLUB BLVD Date of Testing/Service: 10/0812009 <br /> D. Results of Testing/Servicing <br /> Software Version Installed: 327.04 <br /> Complete the following checklist: <br /> x Yes No• Is the audible alarm operational? <br /> ® Yes ❑No* Is the visual alarm operational? <br /> Q Yes No* Were all sensors visually inspected,functionally tested,and confirmed operational? <br /> Yes No <br /> Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not <br /> ❑ <br /> interfere with their proper operation? <br /> x Yes No` N/A If alarms are relayed to a remote monitoring station,is all communications equipment(e.g. modem)operational? <br /> For pressurized piping systems,does the turbine automatically shut down if the piping secondary containment <br /> ❑ Yes [:]No* 0 N/A monitoring system detects a leak,fails to operate,or is electrically disconnected?if yes:which sensors initiate positive <br /> shut-down?(check all that apply) ❑ Sump/Trench Sensors; ❑ Dispenser Containment Sensors. <br /> Did you confirm positive shut-down due to leaks Sad sensor failure/disconnection? ❑ Yes ❑ No <br /> ❑x Yes ❑No• ❑NIA For tank systems that utilize the monitoring system as the primary tank overfill waming device(i.e.: no mechanical <br /> overfill prevention valve is installed),is the overfill warning alarm visible and audible at the tank fill points(s)and operating <br /> properly? If so,at what percent of tank capacity does the alarm trigger? 20 1-% <br /> Yes' ❑X No Was any monitoring equipment replaced?If yes,identify specific sensors,probes,or other equipment replaced and list the <br /> manufacturer name and model for all replacement parts in Section E, below. <br /> ❑ Yes* ®No Was liquid found inside any secondary containment systems designed as dry systems?(check all that apply) ❑product; <br /> ❑ Water. If yes,describe causes in Section E,below. <br /> Yes ❑No Was monitoring system set-up reviewed to ensure proper settings?Attach set-up reports,if applicable. <br /> [ffY e]s Is all monitoring equipment operational per manufacturers'specifications? <br /> "In Section E below,describe haw and when these deficiences were or will be corrected. <br /> E. Comments: <br /> OVERFILL ONLY <br /> Page 2 of 3 Based on CA form dated 03101 <br />