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",- .`INmnitoringSys-tem Certification <br />.Site Address:: �3 7 �A 953 �, Date ofTesiingroervicM - � / n <br />JD. Results of Testing/Servicinig.- <br />Software Version Installed: / S, <br />Complete the following checklist: - FVEL <br />Yes ❑ No* Is the audible maim operational? <br />: �tEREIUNk1U GUIU-lUU 14 <br />Y ®No . Is tix o ? - <br />Yes o* Were all y' y d edope kEjjzl) �y U7 ,3 1 <br />'. Yes ❑ No* Were all sensors installed at lowesfpoint dfs66ondary contamment and po:t°tUL�ULE T -• <br />T�JNkk <br />not interfere with their proper operation?t (STEF1 <br />Yes ❑ No* If alarms are relayed to $ remota monitoring statidn, is all uni F'kk1uU1 IN-TAN1 TE TE <br />_ �NtJUHL . <br />❑ WA operational? <br />Yes ❑ No* <br />❑ N/A - <br />fqj.ycs <br />Por pressurized piping does the tmbinc atdomaticallysihitt down if t <br />monitoring rystetn detects a I toor is ci . - CCU <br />positive shut -down? (Checkall that apply) . Sump/Treuch Disp <br />- 'Did you confirm positive shut -down dud to leaksand sensor faiilutr! ' <br />❑ No* <br />For•tank systems that utilize-thc motiitosmg 'as-tho pridmy tajik of <br />- -:"O.-VA <br />mcchanical'osrerfill prevention valVe•is; ed), is the ovcrfill.warning alarm, <br />-fiilpomt(s) and op=ting pro <Ifso, at of i , urggez? <br />❑ No • <br />:Was any g ent r ? Ifyes, ' orother• equiplrieut rcplaccd- <br />. <br />and list the manufactamr namc-aud model for all replacementparts is Section E, below:..... •- - <br />•0 - Nd.. <br />- Waslquid, found - ' ( �PP1 <br />r <br />-13 W - - - <br />A ow - <br />, c" . -13 No <br />'Yes - .®« <br />Isallrn cut s us? _ •. <br />*In Section E below; describecrow-and when these deficiencies were or wf die corrected.- - - - <br />.. L+ Comments: <br />�"{ rl- of e � � - � Q � 1\ J,1 � � e. S 4 ii �-S - iJ <br />r-L tRE <br />< -422 <br />_ <br />G a.M oa <br />Page 2 -of 3 <br />