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Monitoring System Certification <br /> ti <br /> Site Address: 12,3 7 S Qt6l rfl Date of Testing/Servicing: <br /> D. Results of Testing/Servicing <br /> -Software Version Installed: 1A !j j <br /> Complete the following checklist: <br /> Yes ❑ No* Is the audible alarm operational? <br /> -Yes ❑ No* Is the visual alarm operational? <br /> ❑ Yes ❑ No* Were all sensors visually inspected,functionally tested,and confirmed operational? <br /> 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 /> C�rYes ❑ No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) <br /> ❑ N/A operational? <br /> 0--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 initiate <br /> positive shut-down? (Check all that apply)XfSump/Trench Sensors; JkDispenser Containment Sensors. <br /> Did you confirm positive shut-down due to leaks and sensor failure/disconnection? V?Tes; ❑No. <br /> ❑ Yes ❑ Into* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no <br /> ,19,N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank <br /> fill point(s) and operating properly? If so,at what percent of tank capacity does the alarm trigger? % <br /> 6 Yes* ❑ No' Was any monitoring equipmentzeplaced? 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* 8 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 /> J,Yes ❑ No* Was monitoring system set-up reviewed to ensure proper settings? <br /> AZ Yes ❑ 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: L 1 k M e,elL <br /> w/4 5- `t/A/ <br /> /1 �ihc n. 7P1S6� C✓i a zGII yi 4 - <br /> _ / <br /> /t�bX/ yrb.Q i A/ <br />