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MdWring System Certification • <br /> Site Address: 1250 N. WILSON WAY Date of Testing/Service: 04/19/2006 <br /> D. Results of Testing/Servicing <br /> Software Version Installed: 325.02 <br /> Complete the following checklist: <br /> X Yes No- Is the audible alarm operational? <br /> 0 Yes _LJNo' Is the visual alarm operational? <br /> 0 Yes No' Were all sensors visually inspected,functionally tested,and confirmed operational? <br /> Yes ❑No. Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not <br /> X❑ <br /> interfere with their proper operation? <br /> Yes No' M 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 /> X❑ Yes ❑No' ❑N/A monitoring system detects a leak,fails too rate,or is electrically disconnected?If yes:which sensors initiate positive <br /> shutdown?(check all that apply) ESumprFrench Sensors; X❑ Dispenser Containment Sensors. <br /> Did you confirm positive shutdown due to leaks atdsensor failure/disconnection? ❑X Yes El No <br /> X❑ Yes ❑No ❑N/A For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.:no mechanical <br /> 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 alar trigger? e0 <br /> ❑ Yes' ❑X 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 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 /> X❑ Yes ❑No Was monitoring system set-up reviewed to ensure proper settings?Attach set-up reports,if applicable. <br /> X❑ 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 Based on CA form dated 03/01 <br />