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RECEIVED <br /> D. Results of Testing/Servicing MAY 12 2017 <br /> Software version Installed: ENVIRONMENTAL HEALTH <br /> Complete the followinchecklist: DEPARTMENT <br /> X Yes ❑ No' Is the audible alarm operational? <br /> X Yes I No' Is the visual alarm operational? <br /> X Yes ❑ No' Were all sensors visually inspected,functionally tested,and confirmed operational? <br /> X Yes ❑ No' 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 [i No' If alarms are relayed to a remote monitoring station,is all communications equipment(e.g.modem)operational? <br /> X WA <br /> X Yes L No' For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monitoring system <br /> ❑ WA detects a leak,fails to operate,or is electrically disconnected? If yes:which sensors initiate positive shut-down? (Check al/that apply) <br /> X Sumprrrench Sensors; Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor <br /> failure/disconnection? X Yes; No. <br /> Yes ❑ No' For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e. no mechanical overfill prevention <br /> X WA 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 alarm trimer? % <br /> X 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' X NoWas liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) ❑ Product: Water. If <br /> es,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 /> X Yes ❑ No' I 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 Certification Page 2 of 4 law <br /> 2 2/21/07 <br />