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NW <br />D. Results of Testing/Servicing <br />Software Version Installed. <br />Complete the followina checklist: <br />RECEIVED <br />FEB 12 2016 <br />ENVIRONMENTAL <br />HEALTH r%FPARTMFNT <br />X Yes <br />No* <br />Is the audible alar operational? <br />X Yes <br />No* <br />Is the visual alar operational? <br />X Yes <br />❑ No• <br />Were all sensors visually inspected, functionally tested, and confirmed operational? <br />X Yes <br />❑ NW <br />Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their <br />proper operation? <br />❑ Yes <br />❑ No` <br />If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? <br />X WA <br />X Yes <br />❑ No' <br />For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monitoring system <br />❑ WA <br />detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shutdown? (Check all that apply) <br />- Sumprrrench Sensors; -: Dispenser Containment Sensors. Did you confirm positive shutdown due to leaks and sensor <br />failureldisconnection? [I Yes; No. <br />❑ Yes <br />i i No* <br />For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no mechanical overfill prevention <br />X WA <br />valve is installed), is the overfill warning alarm visible and audible at the tank fill point(s) and operating properly? If so, at what percent <br />of tank CaPaCItY does the alartrigger.? <br />❑ Yes' <br />X No 1 <br />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' <br />X No <br />Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) ❑ Product; Water. ti <br />s, describe causes in Section E, below. <br />X Yes <br />❑ No <br />Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable <br />X Yes <br />- No' <br />Is all monitoring equipment 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 />Monitoring System Certlflcation Page 2 of 4 12/07 <br />2 <br />2/21/07 <br />