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RECEIVED <br /> NOV 0 7 2016 <br /> D. Results of Testing(Servicing ENVIRONMENTAL HEALTH <br /> Software Version Installed: 123.02 DEPARTMENT <br /> ornpletethe followt checklist: <br /> x Yes 0 No' Is the audible alarm operational? <br /> x yes 11 No* Is the visual alarm operational? <br /> x Yes o No* Were all sensors visually iTjmcled.functionally tested,and confirmed operational? <br /> x Yes 0 No* Were all sensors Installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their <br /> p per operation? <br /> 0 Yes 0 Ne If alarms are relayed to a remote monitoring station,is all communications equiprnent(e.g.modem)operational? <br /> x N/A <br /> x Yes 0 Ne I For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monitoring system <br /> C1 N/A detects a leak,falls to operate,or is electrically disconnected? If yes:which sensors initiate positive shut-down? (Check all that apply) <br /> 0 SumplTrench Sensors; 0 Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor <br /> failureldisconnection? 0 Yes; 0 No. <br /> 0 Yes 0 Ne For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.no mechanical overfill prevention <br /> x NIA 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 capacity does the alarm trigger? % <br /> 0 Yee 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 its in Section E,below. <br /> 0 Yes* x No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply)0 Product 0 Water, If <br /> I ,describe causes in Section E,below. <br /> x Yes I o No* Was monitoring system set-up reviewed to ensure proper settings?Attach set up reports,K applicable <br /> Lx Yes <br /> I C1 No- Is all monitoring equipment operational per manufacUirer'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 Pap 2 of 4 121011 <br /> 2 2/21/07 <br />