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7UL-04-2007 13:35 Service Station Systems 408 938 8888 P.03 Monitoring System Certification-Pa+of 3 . Site Address: 4219 Morada Ln. Date of Testing/Servicing. (e D. Results of Testing/Servicing Software Version Installed• t7-7 Complete the following checklist: Yes 1 0 NO Is the audible alarm operational? Yes 0 No* Is the visual alarm operational? Yes ❑ No* Were all sensors visually inspected, functionally tested, and confirmed operational? Yes ❑ No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? ❑ Yes ❑ No* if alarms are relayed to a remote monitoring station, is all communications equipment(e.g. modem) ID N/A operational? A Yes 11 No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment ❑ N/A monitoring system detects a leak, fails to operate, or is electrically discomiected? If yes: which sensors initiate positive shut-down? (Check all that apply) b Sump/Trench Scissors; N Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? Q Yes 0 No 1p Yes a No* For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.no ❑ N/A mechanical overfill prevention 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 of tank capacity does the alarm trigger? 9d . % 0 Yes* 1 No Was any monitoring equipment replaced? If yes, identify specific sensors,probes, or other equipment replaced and list the manufacturer name and model for all replacement arts in Section E,below. 0 Yes* !�No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) 0 Product;0 Water, if yes,describe causes in Section E,below. Yes 0 No* Was monitoringsystem set-up reviewed to ensure proper settings? Attach set-upreports, i a licable. "l Yes 0 No* is all monitoring equipment operational per manufacturers specifications? * In Section E below,describe how and when these deficiencies were or will be corrected. E. Comments: Y �-- 7S93C�- 1� r ;� 43 _ 3cl