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itoring System Certification <br /> Site Address: 401 W. KETTLEMAN LANE Date of Testing/Service: 03/04/2005 <br /> na S. LEE AVE. QC-D3 <br /> D. Results of Testing/Servicing <br /> Software Version Installed: 122.00 <br /> Complete the following checklist: <br /> x Yes No* Is the audible alarm operational? <br /> ❑x Yes ❑No Is the visual alarm operational? <br /> ❑x Yes No* Were all sensors visually inspected,functionally tested,and confirmed operational? <br /> Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not <br /> Yes ❑No' interfere with their proper operation? <br /> x Yes No* NIA If alarms are relayed to a remote monitoring station,is all communications equipment(e.g.modem)operational? <br /> For pressurized piping systems,does the turbine automatically shut down if the piping secondary containment <br /> ❑x Yes ❑No* ❑NA monitoring system detects a leak,fails to operate,or is electrically disconnected?If yes:which sensors initiate positive <br /> shut-down?(check all that apply) El Sump/Trench Sensors; ❑x Dispenser Containment Sensors. <br /> Did you confirm positive shut-down due to teaks and sensor failure/disconnection? 0 Yes ❑No <br /> ❑ Yes ❑No* ®NIA For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.:no mechanical <br /> overfill prevention valve is installed),is the overfill warning alarm visible and audible at the tank fill points(s)and operating <br /> properly? If so,at what percent of tank capacity does the alarm trigger? % <br /> ® Yes* M 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* M No Was liquid found inside any secondary containment systems designed as dry systems?(check all that apply) ❑Product; <br /> ❑ Water. If yes,describe causes in Section E,below. <br /> x❑ Yes ❑No* Was monitoring system set-up reviewed to ensure proper settings?Attach set-up reports,if applicable. <br /> 0 Yes ❑No* Is all monitoring equipment operational per manufacturers'specifications? <br /> In Section E below,describe how and when these deficiences were or will be corrected. <br /> E. Comments: <br /> Page 2 of 3 Based on CA form dated 03/01 <br />