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1,2/01/2005 12:17 16613637474 CHAMPION PT INC PAGE 06 <br /> Monitoring Sym ceraftation <br /> of Tes. Senricin <br /> Site Address: Daft � g• <br /> D. Results of Testing/Servicing <br /> r <br /> software Version installed: <br /> Com the f ng chwklisb <br /> "Yes [I No* is the alible alarm o oust? <br /> es ❑ No' is the visual alarm 'onal7 <br /> C] Yes 0rNo* Were all in functiaaw iest4 and confirmed oral? <br /> I 'Yes Cl No* Were all tensors i=Wed at lowest point of secondary con and Positioned so that other egr►ipnnerrt <br /> will not intErf=with their . <br /> ❑ 'Yes ❑ No* If alarms are relayed to a temote monitoring station, is all oornmat ication�s egwiprmeAt (e.g. modcm) <br /> CSN/A operational? <br /> Cf'Xes [❑ No* For Wtwm=d pining systems,does the turbine antomaticaily shut down if the piping secondary contaiument <br /> ❑ NIA motoring system, darts a teot, fails to operate, or is el diseonnected? if yes: which sensors <br /> initiate pmitive shut-dotim? Oeck all that apply) p�Su Ttcnch S�nsors; DiSpcatser Containment <br /> Sensors. <br /> Did you co�rrEirm positive shutAown due to leaks and Caitur�J- - ection? I.�''"Ycs, ®No. <br /> Q Ycs ❑ No* For tank systems that utilise the monitoring system as the primary taAk overR11 -warning device (i.e. no <br /> CrW/A mechanical overfill prevention valve is installc d), is the ove6n alarm visible and audible at the tank <br /> fill i s and o in l 1fsQatwhaVm=t of tank docs the alarm.tri er? ?7??"/a <br /> p Yes* O No Was any monitoring equipment replaced? If yrs, identify specific sekisorS, probes, or olber equipment <br /> replawd and list the wanrtfacturer name and nWel for all rolin.Section E,below. <br /> ❑ Yom* p'No Was liquid Jbmd inside any secondary containment s designed as dry ms? (Check all that apply) <br /> ❑Product Q Water. if be causes in Section B below. <br /> Yes ® No* Was monitoring set- reoewed to ? <br /> Yes Ci No* 1 Is all xrtcnt 'onal Er ma 's oatior7 <br /> *In Stenon F,Maw,deneribe how and when these dellcle0des were Or will bee cued. � <br /> T. Comments: <br />