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Monitoring System Certification <br />Site Address: 4 S'4 CK(''0Kd-'Z-:- LN 41�) r Date of Testing/Servicing: <br />D. Resuits of Testing/Servicing <br />Software Version Installed: -52517S 3 -0,----z A <br />Complete the following checklist: <br />O'Yes <br />❑ No* <br />Is the audible alarmoperational? <br />Er Yes <br />❑ No* <br />Is the visual alarm operational? <br />B'Yes <br />❑ No* <br />Were all sensors ysually inspected, functionally tested, and confirmedoperational? <br />EJOTes <br />❑ No* <br />Were all sensors installed at lowest point of secondary containment and positioned so that other equipment <br />will not interfere with their proper operation? <br />�yfes <br />❑ No* <br />If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) <br />p -'N/A <br />I operational? <br />❑ Yes <br />p'lNo* <br />For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment <br />❑ N/A <br />monitoring system detects a leak, fails to operate, or is electrically disconnected? if yes: which sensors <br />initiate positive shut -down? (Check all that apply) 9-5umpfrrench Sensors; ❑ Dispenser Containment <br />Sensors. <br />Did you confirm positive shut -down due to leaks and sensor Witire/disc onnection? 2r%s; ❑ No. <br />❑ Yes <br />❑ No* <br />For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no <br />2 -N/A <br />mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank <br />fill int(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? M?% <br />❑ Yes* <br />©"NoWas <br />any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment <br />laced and list the manufacturer name and model for all replacement parts in Section E, below. <br />❑ Yes* <br />lrRo <br />Was liquid found inside any secondary containment systems designed as dry systems? (Check all That apply) <br />❑ Product, ❑ Water. If yes, describe causes in Section E. below. <br />Oe -yes <br />❑ No* <br />Was monitoring set-up reviewed to ensure proper settings? � <br />p'i'es <br />❑ No* <br />Is all monitoring ui ment 22Eptional per manufacturer's sications? <br />* In Section E below, describe how and when these deficiencies were or will be corrected. <br />E. Comments: rff�' �/�s , tZ.-C Fsk & 5 I T 061,-' I., L3 �I t--7- <br />L Jb/e 4125' <br />Fes+, A. "L' I -I N u c SC 5 ) I <br />