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RECEIVED <br /> D. Results of Testing/Servicing OCT 2 8 2016 <br /> Software Version Installed: <br /> Complete the following checklist: <br /> ENVIRONMENTAL HEALTH <br /> X Yes j 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 f No' Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their <br /> roper operation? <br /> Yes X No' If alarms are relayed to a remote monitoring station,is ail communications equipment(e.g.modem)operational? <br /> r WA <br /> X Yes a No' For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monitoring system U; <br /> NIA detects a leak,fails to operate,or is electrically disconnected? If yes:which sensors initiate positive shut-down? (Check all that apply) 1- V `. <br /> L Sump/Trench Sensors; U Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor <br /> failure/disconnection? L Yes; U No. <br /> Yes O No` For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.no mechanical overfill prevention <br /> X N/A valve is installed),is the overfill warning alarm visible and audible at the tank fill point(s)and operating properly? If so,at what percent ' <br /> of tank capacity does the alarm trigger? % <br /> i Yes` X No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the <br /> manufacturer name and model for all replacement parts in Section E,below. <br /> i Yes' X No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply)L i Product; F,,Water. If <br /> es,describe causes in Section E,below. <br /> X Yes 0 No' Was monitoring system set-up reviewed to ensure proper settings?Attach set up reports,if applicable <br /> X Yes n No' Is all monitoring equipment operational per manufacturer's specifications? <br /> "In Section E below,describe how and when these deficiencies were or will be corrected. <br /> E. Comments: <br /> Monitoring System Certification Page 2 of 4 12/07 <br /> 2 2/21/07 <br />