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',;IleAddicss: 2 I 4261-)/14:� Date of Testing/Servicing: <br /> 1). RCS111ls of TeslinK/Servicing <br /> C„(lwarc Version Ins(allcd: <br /> Complete the followin checklist: �— <br /> Yes ❑ No* 1s (lie audible alarm operational'? <br /> _ <br /> Yes ❑ No* Is(lie visual alarm operational'? <br /> Yes ❑ No* Were all sensors visuallyinspected, functionally tested, and confirmed operational? <br /> Yes ❑ No* Were all sensors installed at lowest point of secondary containment and positioned so Ihat other equipment will <br /> _ not interfere with their proper operation? <br /> [] Yes ❑ No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) <br /> N/A operational'? <br /> rg. Ycs ❑ No* for pressuiizcd piping systems, does (lie turbine automatically shut down it the piping secondary conlailunent <br /> ❑ 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) RSump/Trench Sensors; [•Dispenser Containment Sensors. <br /> Did you confirm positive shut-do«m 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 warning device (i.e. no <br /> ❑ N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank <br /> fill oral s and operating properly? If so,at what percent of tank capacity docs the alarm trigger? ????% <br /> Yes* No Was any monitoring equipment replaced? if yes, identify specific sensors, probes, or other equipment replaced <br /> Land list the manufacturer name and model for all replacement parts in Section E,below. <br /> hoYes* ❑ No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) El <br /> Product; ❑Water. IC es, describe causes in Section E,below. <br /> [?Q Yes ❑ No* Was monitoringsystem set-upreviewed to ensure proper settings? <br /> Yes ❑ No* Is all monitoring equipment oerational per manufacturer's specifications? <br /> * In Section E below,describe how and when these deficiencies were or will he corrected. <br /> I";. Conunents: <br /> Page 2 of 3 03101 <br />