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Monitoring System Certification <br /> Site A Date of Testing/Servicing: <br /> A Results of Testing/Servicing <br /> Software Version Installed: �-- <br /> Complete the fo 'ng checklist: <br /> GKYes ❑ No* Is the audible alarmoperational? <br /> (yYes ❑ No* IS the visual alarm operational? <br /> ❑ Yes RrNo* Were all sensors visually msWctrA fimetionally tested,and confirmed "oral? <br /> ( Yes ❑ No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment <br /> will not interfere with their pgM operation?_ <br /> ❑ Yes ❑ No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) <br /> [2r-Ft/A operational? <br /> W Yes ❑ No* For pressurized piping systems,does the turbine automatically shut down if the piping secondary containment <br /> ❑ N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors <br /> initiate positive shut-down? (Check all that apply) eSump/Trench Sensors; Dispenser Containment <br /> 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 warning device (i.e. no <br /> [jrN/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank <br /> fillpoint(s)and operating property? If so,at what percent of tank capacity does the alarm trigger? ?'???% <br /> ❑ Yes* No Was any monitoring equipment rep ? If yes, identify specific sensors, probes, or other equipment <br /> repla and list the manufacturer name and model for all replacement parts in Section E,below. <br /> ❑ Yes* T rNo 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 /> Yes ❑ No* Was monitoring set-up reviewed to ensure ffcEg settings? <br /> Yes ❑ No* Is all monitorin Ld menta rational per man is ons? <br /> *In Section E below,describe how and when these deficiencies were or will be co <br /> E. Comments: � d�<- s ��' �n ! n, r- ,✓ ,� '�`" t36= i� ic��y ' <br />