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01 kiciv t <br /> NOV 16 2016 <br /> D. Results of Testing/Servicing ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> Software Version Installed: <br /> Com lets the followin checklist: <br /> X Yes 0 No* Is the audible alarm operational? <br /> X Yes 0 No* Is the visual alarm operational? <br /> X Yes ri No* Were all sensors visually inspected,functionally tested,and confirmed operational? <br /> X --T— a positioned so that other equipment will not interfere with their <br /> Yes No* Were all sensors installed at lowest point of secondary contammenI an <br /> pr per o ration? <br /> Yes If alarms are relayed to a remote monitoring station,is all communications equipment(e.g.modern)operational? <br /> o N/A —monitoring system <br /> Yes j—Ne pressurized piping systems, does the turbine automatically shut down if the piping secondary containment <br /> X NIA detects a leak,fails to operate,or is electrically disconnected? If yes:which sensors initiate positive shut-down? (Check all that apply) <br /> 0 Sump(rrench Sensors-, 0 Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor <br /> failure/disconnection? D Yes; U No. m- device(i.e.no mechanical overfill prevention <br /> Yes o No* For tank systems that utilize the monitoring system as the primary tank over-r-111 warning <br /> X N/A valve Is installed),is the overfill warning alarm Visible and audible at the tank fill point(s)and operating property? If so,at what percent <br /> of tank ca ' d—:il the alarm tri er? - % I—i::il,it . <br /> n Yes* X No as any monitoring equipment replaced? If yes, Identify specific sensors, or other equipment replaced and fist the <br /> manufacturer name and model for all re cement parts in Section E,below. <br /> n Yes* -WW—iWid found Ins' e any secondary containment systems designed as dry systems. (Check all that apply)I j Product; 0 Water. If <br /> . yes,describe causes in Section E,below. <br /> X Yes n No* I as monitoring system set-up reviewed to ensure proper settings?Attach set up reports,If applicable <br /> X Yes 7: Li monitoring equipment operational per manufacturer's specifications? <br /> •In Section E below,describehowand when these deficiencies were or will be corrected. <br /> E. Comments: <br /> Monitoring System Certification Page 2 of 4 I2!07 <br /> 2 2/21/07 <br />