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JUL-11-2011 10:48 Service Station Systems 408 938 8888 P.03 <br /> Monitoring System Certification-Page 2 of 3 <br /> Site Address: 3505 Navy Dr. Date of Testing/Servicing; 6/27111 <br /> D. Results of Testing/Servicing <br /> Software version Install,(I- 4.003 <br /> Com tete the fallo ing checklist: <br /> M Yes ❑ No* fs the audible alarm operational? <br /> ® Yes ❑ No* Is the visual alarm operational? <br /> m Yes ❑ No* Were all sensors visually inspected, functionally tested,and confirmed operational? <br /> ® Yes ❑ No* Were all sensors instalied at lowest point of secondary containment and positioned so that other equipment will <br /> not interfere with their proper operation'? <br /> ❑ Yes ❑ No* If alarms are rclaycd to a remote monitoring station,is ail communications equipment(e.g.modem) <br /> IN N/A operational? <br /> ❑ Yes ❑ Nog For pressurised piping systems,does the turbine automatically shut down if the piping secondary containment <br /> N N/A monitoring system detects a leak,fails to operate,or is electrically disconnected? If yes;which sensors initiate <br /> positive shut-down'? (Check all that apply) 0 Sump/Trcneh Sensors; ❑ Dispenser Containment Sensors. <br /> Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ❑ Yes ❑ No <br /> ❑ Yes ❑ No* For tank systems that utilize the monitoring system as the primary tank overfill warring device(i.e.no <br /> 0 N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank <br /> fill int(s)and operating roperly? If so,at what percent of tank capacity does the alarm trigger? 0 % <br /> ❑ Yes* 0 No Was any monitoring equipment replaced?if yes, identify specific sensors,probes,or other equipment replaced <br /> and list the manufacturer name and model for all replacement parts in Section E,below. <br /> D Yes* ® No 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 F:,below- <br /> ® Yes ❑ No* Was monitoring system set-u rcvicwed to ensure proper satin s? Attach set-u re orts, if a )'licable. <br /> ® Yes ❑ No* Is all monitoring equipment operational per manufacturer's specifications? <br /> In Section F.below,describe how and when these deficiencies were or will be corrected. <br /> E. Comments: <br />