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�itoring System Certification • <br /> Site Address: 470 N MAIN ST Date of Testing/Service: 12/02/2003 <br /> D. Results of Testing/Servicing <br /> Software Version Installed: 16.05 <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 FX-1 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' ❑N/A monitoring system detects a leak,fails too erste,or is electrically disconnected?If yes:which sensors initiate positive <br /> shut-down?(check all that apply) 1XI Sump/Trench Sensors; ❑ Dispenser containment Sensors. <br /> Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ❑ Yes M No <br /> N/A For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.:no mechanical <br /> © ves ❑No• ❑ 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? 90 % <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 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 /> © Yes ❑No` Is all monitoring equipment operational per manufacturers'specifications? <br /> 'In Section E below,describe how and when these deficiences were or will be corrected. <br /> E. Comments: <br /> page 2 of 3 <br />