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�nitoring System Certification <br /> Site Address: 4747 WEST LANE Date of Testing/Service: 03/26/2001 <br /> D. Results of Testing/Servicing <br /> Software Version Installed: <br /> Complete the following checklist: <br /> El Yes [:]No• Is the audible alarm operational? <br /> Yes E]No' Is the visual alarm operational? <br /> ® Yes 0 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 /> ® Yes No• interfere with their proper operation? <br /> Yes No' Lj 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 /> E] Yes 0 No• ®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; �i�ii Dispenser Containment Sensors. <br /> Did you confirm positive shut-down due to`Teaks and sensor failure/disconnec on? Yes No <br /> Yes E]No• N/A For tank systems that utilize the monitoring system as the primary tank overfill warning 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? % <br /> ❑ Yes ®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• as liquid found inside any secondary containment systems designed as dry systems?(check all that applr]Product; <br /> ❑ Waterlf 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 /> ® Yes No' Is all monitoring equipment operational per manufacturers specifications? <br /> In Section E below,describe how and when these decifences were or will be corrected. <br /> E. Comments: <br /> page 2 of 3 <br />