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Monitoring System Certification <br />Site Addreis:. <br />A -Results of Testing/Ser%viicirig. <br />Software Version Installed. - <br />Complete the following check&st: <br />Date of Testing/Servicing. i <br />Yes <br />❑ No* <br />Is the audible alarm operational? <br />Yes ' <br />❑ No* <br />. Is the visual alarm operational? <br />Ye <br />(3 No* <br />Were all 'sensors visualiyhLVected, f fictionally tested, and confirmed operational? <br />Yes <br />(3 No* <br />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 />Yes <br />Cl No* <br />If alarms are relayed to a remote monitoring statidn, is all communications equipment (e g. modem)- <br />❑ NIA <br />operational? <br />Ayes Yes - <br />❑ No* <br />For premnized piping systems, does the turbine automatically, shut down if the piping secondary containment <br />A - <br />monitoring system detects a leaf fails to operate,.or is elodridaUy disconnected? If yes: which sensors initiate <br />positive shut -down? (Checkall Hurt apP.`Y)Sumprrrench Sensors; Cl Dispenser Containment Sensori. <br />'Did you confirm positive shut -down due to leaks and sensor faflurrJdisconnection? OVYes; QNo_ <br />-o-yes <br />❑ No's. _ <br />For .tank systems brat utilize -the' monitoring system -as- the pr chary tank 'overfill warning device (Le. no <br />_ <br />❑` /J, <br />mechanical'oyerfili prevention•vaWt-is installed), is the ove fll warning alarm visible and audible at the tank <br />1fill <br />points) and g properl3ft-.If so, at whatpetnt ®f tank cagarity does.the alarm trigger? % <br />• ❑ 'Yes*: <br />No <br />Was any monitoring equipment replaced? 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 />es* <br />❑ No'- <br />Was liquid found inside any secondary containment systems dwigned as dry *,stens? (Greek am that apply) <br />13Producs; atx~r_: Ifyes, des -be causes iia Secdon E; below.. . <br />Yes <br />'❑ Ne <br />Was monitoring system sd-up reviewed to enure pre>per settings? . <br />Yes <br />❑ 'No* <br />Is all mo4horm g6qujpmeqtopezadon.l per manufactuer s specifications? .. ' . <br />*In Section E below; describe hoivand when these deficiencies were or will fie corrected. • - <br />E. Comments: LtAztc 4,0r� <br />CALM -01 Page 2.of 3 ' 11/x5/99 <br />