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ENSOR SFUNCTIONALITY TESTING Facility Name: Owner. Address: Address: City, State, Zip Code: City, State, Zip Code: Facility I.D. M Phone #: Testing Company. Phone #: Date: This procedure is to determine whether liquid sensors located in the interstitial space of UST systems are able to detect the presence of water and fuel. See PEVRP1200 Section 8.3 for the test procedure. Sensor Location Product Stored ❑ Discriminating ❑ Discriminating ❑ Discriminating ❑ Discriminating ❑ Discriminating ❑ Discriminating ❑ Discriminating Type of Sensor ❑ Non-discrimi- ❑ Non-discrimi- ❑ Non-discrimi- ❑ Non-discrlmi- ❑ Non-discrimi- ❑ Non-discrimi- ❑ Non-dlscrimi- nating nating nating nating nating nating nating ❑ Water ❑ Water ❑ Water ❑ Water ❑ Water ❑ Water ❑ Water Test Liquid ❑ Product ❑ Product ❑ Product ❑ Product ❑ Product ❑ Product ❑ Product Is the ATG console clear of any active or recurring warnings or alarms regarding the leak sensor? If the ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No sensor is in alarm and functioning, indicate why. Is the sensor alarm circuit ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No operational? Has sensor been inspected and in ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑Yes ❑ No []Yes ❑ No good operating condition? When placed in the test liquid, does ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No the sensor trigger an alarm? When an alarm is triggered, is the sensor properly identified on the ATG ❑ Yes ❑ No ❑ Yes ❑ No ❑Yes ❑ No ❑ Yes ❑ No ❑ Yes []No ❑ Yes ❑ No ❑ Yes ❑ No console? Any "No" answers indicates the sensor fails the test. Test Results ❑ Pass D Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fall ❑ Pass ❑ Fail ❑Pass ❑Fall ❑ Pass ❑ Fall ❑ Pass ❑ Fail Comments: Tester's Name (print) Tester's Signature