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RECEIVED <br /> D.Results of Testing/Servicing N O V 2 4 2014 <br /> Software Version Installed: 333.03 <br /> Complete the following checklist: ENVIRONMENTAL HEALTH <br /> • Yes No* Is the audible alarm operational? <br /> • Yes r No* Is the visual alarm operational? <br /> • Yes r No* Were all sensors visually inspected,functionally tested,and confirmed operational? <br /> • Yes r No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with <br /> heir proper operation? <br /> • Yes No* If alarms are relayed to a remote monitoring station,is all communications equipment(e.g.modem)operational? <br /> N/A <br /> • Yes r No* For pressurized piping systems,does the turbine automatically shut down if the piping secondary containment monitoring <br /> system detects a leak,fails to operate,or is electrically disconnected?If yes:which sensors initiate positive shut-down?(Check <br /> N/A all that apply)P Sump/Trench Sensors; r Dispenser Containment Sensors. <br /> Did you confirm positive shut-down due to leaks and sensor failure/disconnection?+: Yes; r No <br /> • Yes r No* For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.no mechanical overfill <br /> prevention valve is installed),is the overfill warning alarm visible and audible at the tank fill point(s)and operating properly?If <br /> • N/A 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 and list the <br /> manufacturer name and model for all replacement parts in Section E below. <br /> • Yes* r Noas 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 /> • Yes No* as monitoring system set-up reviewed to ensure proper settings?Attach set up reports,if applicable <br /> o Yes r No* s all monitoring equipment operational per manufacturer's specifications? <br /> *In Section E below,describe how and when these deficiencies were or will be corrected. <br /> E.Comments: <br /> 1 gal of liquid removed from sup stp sump,and 3 gal of liquid removed from reg fill sump. <br /> Monitoring System Certification Page 2 of 3 12/07 <br />