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l0nitoring System Certification • <br /> Site Address 1 153 E 11TH ST Date of Testing/Service: 02/09/2010 <br /> QC-D-3 <br /> D. Results of Testing/Servicing <br /> Software Version Installed: 17.01 <br /> Complete the following checklist: <br /> X Yes No. Is the audible alarm operational? <br /> Q Yes No• Is the visual alarm operational? <br /> ❑X Yes No• Were all sensors visually inspected,functionally tested,and confirmed operational? <br /> Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not <br /> Q Yes ❑No' interfere with their proper operation? <br /> Yes No• x 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 /> ❑x Yes ❑No' ❑N/A monitoring system detects a leak,fails to operate,or is electrically disconnected? <br /> IfDispensers:whichConsensors <br /> inensonitiate rsosifive <br /> shut-down?(check all that apply) Ox Sump(rrench Sensors; <br /> Did you confirm positive shut-down due to leaks and sensor failure/disconnecfion? ❑x Yes No <br /> EYes N/A For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.:no mechanical <br /> ❑ ❑No• ❑ overfill prevention valve is installed),is the overfill warning alarm visible and audible at the tank fill points(s)and operating <br /> propedy. If so,at what percent of tank capacity does the alarm trigger? 90 <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,belowry y y) ❑ <br /> Product; <br /> ❑ Yes' ❑x No Was liquid found inside any secondary containment systems desi ned as d ppI <br /> ❑ Water. If yes,describe causes in Section E,below. <br /> ❑X Yes ❑No• Was monitoring system set-up reviewed to ensure proper settings?Attach set-up reports,if applicable. <br /> ❑ Yes ❑No• Is all monitoring equipment operational per manufacturers'specifications? <br /> .In Section E below,describe how and when these defrciences were or will be corrected. <br /> E. Comments: <br /> Page 2 of 3 Based on CA form dated 03/08 <br />