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Site Address: 1987 WEST 11 TH D. Results of Testing/Servicing Software Version Installed: Complete the following checklist: itoring System Certification Date of Testing/Service: 09/08/2003 0 Yes No Is the audible alarm operational? ❑X Yes No Is the visual alarm operational? ❑X 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 N/A If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? © Yes ❑ No ❑ N/A For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut -down? (check all that apply) ❑X Sump/Trench Sensors; ❑x Dispenser Containment Sensors. Did you confirm positive shut -down due to leaks and sensor failure/disconnection? ❑X Yes ❑ No ❑ Yes ❑ No N/A For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e.: no mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill points(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? ❑ Yes' ❑ 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 parts in Section E, below. ❑ Yes' © No Was liquid found inside any secondary containment systems designed as dry systems? (check all that apply) ❑ Product; ❑ Water. If yes, describe causes in Section E, below. El Yes ❑ No' Was monitoring system set-up reviewed to ensure proper settings? Attach set-up reports, if applicable. © Yes ❑ No' Is all monitoring equipment operational per manufacturers' specifications? ' In Section E below. describe how and when these deficiences were or will be corrected. E. Comments: page 2 of 3