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Monitoring System Certification <br />ti Site Address: ( %O6X ciS l►t 1 Lc, i °t n' C A Date of Testing/Servicing: U l / _?o / <br />D. Results of Testing/Servicing <br />Software Version Installed: <br />Yes <br />❑ No* <br />Is the audible alarm operational? <br />Yes <br />❑ No* <br />Is the visual alarm operational? <br />�! Yes <br />❑ No* <br />Were all sensors visually inspected, functionally tested, and confirmed operational? <br />Yes <br />❑ No* <br />Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will <br />not interfere with their proper operation? <br />❑ Yes <br />❑ No* <br />If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) <br />N/A <br />operational? <br />dYes <br />❑ No* <br />For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment <br />Cl N/Amonitoring <br />system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate <br />shut -down? (Check all that apply) A Sump/Trench Sensors; ❑ Dispenser Containment Sensors. <br />positive <br />Did you confirm positive shut -down due to leaks and sensor failure/disconnection? ❑ Yes; 4 -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 />,0 NIA <br />mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank <br />fill point(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? % 1 <br />Was equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced <br />Q Yes* <br />Al No- <br />any monitoring <br />and list the manufacturer name and model for all replacement parts in Section E, below. <br />❑ Yes* <br />JW_ No <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 />1,�4 yes <br />❑ No* <br />Was monitoring system set-up reviewed to ensure proper settings? <br />G ,..Yes <br />❑ I\io* <br />Is all monitoring equipment operational per manufacturer's specifications? <br />* In Section E below, describe how and when these oeticiencies were or win ue cmc L c—cu. <br />E. Comments: <br />CALM -01 Page 2 of 3 <br />iin5:99 <br />