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R JDMonitoring System Certification v <br /> Z Ak <br /> IS2017 <br /> D. Results of Testing/Servicing <br /> Software Version Installed: 3 L1 . 0 ENVIROiq iENTAL HEALTH <br /> O DEPAHTMENT <br /> Complete the following checklist: <br /> X Yes ❑ No* Is the audible alarm operational? <br /> K Yes ❑ No* Is the visual alarm operational? <br /> Jj Yes ❑ No* Were all sensors visually inspected, functionally tested,and confirmed operational? <br /> K Yes ❑ No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will <br /> not interfere with their proper operation? <br /> ❑ Yes ❑ No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g., modem) <br /> K N/A operational? <br /> ® Yes ❑ No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment <br /> ❑ N/A monitoring system detects a leak, fails to operate,or is electrically disconnected? If yes: which sensors initiate <br /> positive shut-down? (Check all that apply) ['}Sump/French Sensors; 4 Dispenser Containment Sensors. <br /> Did you confirm positive shut-down due to leaks and sensor failure/disconnection? PQ Yes; ❑No. <br /> ❑ Yes ❑ No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no <br /> ® N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank <br /> fill point(s)and operating 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 <br /> and list the manufacturer name and model for all replacement parts in Section E,below. <br /> ❑ Yes* RI No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) <br /> ❑Product;tor❑ <br /> WaWater. If yes,describe causes in Section E,below. <br /> �] Yes ❑ No* s moniing system set-up reviewed to ensure proper settings?Attach set up reports,if applicable <br /> Yes No* Is all monitorinlz equipment oerational per manufacturer's specifications? <br /> * In Section E below,describe how and when these deficiencies were or will be corrected. <br /> E. Comments: <br /> Page 2 of 4 <br /> UN-036-2/4 www.unidomorg Rev.01/17/08 <br />