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onitoring System Certification <br /> Site Address: 1234 YOSEMITE AVE Date of Testing/Service: 06/28/2001 <br /> D. Results of Testing/Servicing <br /> Software Version Installed: <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 not <br /> ® <br /> interfere with their proper operation? <br /> ® Yes ❑No* N/A If alarms are relayed to a remote monitoring station,is all communications equipment(e.g.modem)operational? <br /> For pressurized piping systems,does the turbine automatically shut down if the piping secondary containment <br /> ® Yes No* ❑N/A monitoring system detects a leak,fails to operate, or is electrically disconnected?If yes:which sensors initiate positive <br /> shut-down(check all that apply) Sump/Trench Sensors; ❑Dispenser Containment Sensors. <br /> Did you confirm positive shut-down due teaks and sensor failure/disconnections M Yes 0 No <br /> ® Yes No* N/A For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.no mechanical <br /> overfill prevention valve is installed),is the overfill warning alarm visible and audible at the tank fill points(s)and operating <br /> properly? If so,at what percent of tank capacity does the alarm trigger? <br /> E Yes ®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 /> Yes ®No* as liquid found inside any secondary containment systems designed as dry systems?(check all that appl jj Product; <br /> Waterlf yes,describe causes in Section E, below. <br /> ® Yes ❑No* Was monitoring system set-up reviewed to ensure proper settings?Attach set up reports, if applicable <br /> ® Yes R No* Is all monitoring equipment operational per manufacturer's specifications? <br /> *In Section E below,describe how and when these decifiences were or will be corrected. <br /> E. Comments: <br /> page 2 of 3 <br />