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• • RECEIVED <br /> D.Results of Testing/Servicing O C T U 4 2017 <br /> Software Version Installed: 333.03 <br /> Complete the following checklist: ENVIRONMENTAL HEALTH <br /> Yes r No* Is the audible alar operational? <br /> Yes r No* Is the visual alar operational? <br /> Yes r No* Were all sensors visually inspected,functionally tested,and confirmed operational? <br /> Yes r No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with <br /> heir proper operation? <br /> Yes r No* If alarms are relayed to a remote monitoring station,is all communications equipment(e.g.modem)operational? <br /> N/A <br /> Yes No* For pressurized piping systems,does the turbine automatically shut down if the piping secondary containment monitoring <br /> N/A em detects a leak,fails to operate,or is electrically disconnected?If yes:which sensors initiate positive shut-down?(Check <br /> al/Mat apply)r Sump/Trench Sensors; r Dispenser Containment Sensors. <br /> Did you confirm positive shut-down due to leaks and sensor failure/disconnection?r Yes; r No <br /> Yes r No* For tank systems that utilize the monitoring system as the primary tank overall warning device(i.e.no mechanical overfill <br /> r N/A Prevention valve is installed),is the overfill warning alar visible and audible at the tank fill point(s)and operating properly?If <br /> at what percent of tank capacity does the alarm trigger?% <br /> Yes* r No Nas 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* r No as liquid found inside any secondary containment systems designed as dry systems?(Check all that apply) <br /> Product; r Water.If 's, <br /> s describe causes in Section E below. <br /> Ir Yes r No* as monitoring system set-up reviewed to ensure proper settings?Attach set up reports,if applicable <br /> Ir Yes r No* s 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 /> JUST CHECKED IF THE SENSORS IN THE LOWEST POINT AND ALSO FREE OF LIQUID AND TRASH... <br /> Monitoring System Certification Page 2 of 3 12/07 <br />