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i s <br /> A Results of Testing/Servicing <br /> Software Version Installed: <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 /> (x)Yes ❑ No* 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 /> (x)Yes ( )No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) <br /> ( )N/A operational? <br /> ( )Yes ( )No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment <br /> (x)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) ❑ Sump/Trench Sensors; ❑Dispenser Containment Sensors. <br /> Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ❑Yes; ❑No. <br /> (x)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 /> fillpoint(s)and operating ro erl ? If so,at what percent of tank capacity does the alarm trigger? % <br /> ( )Yes* (x)No Was any monitoring equipment replaced? If yes, identify specific sensors,probes, or other equipment replaced <br /> and list the manufacturer name and model for all replacement parts in Section E,below. <br /> ( )Yes* (x)No 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 /> (x)Yes ❑ No* Was monitoring system set-up reviewed to ensure pro2er settings?Attach set up reports,if applicable <br /> (x)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 be corrected. <br /> E. Comments: <br /> Page 2 of 3 03101 <br />