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Monitoring System Certification <br />.'site, Address:. Date of Testing/Servicing: <br />A. Results of Testing/Servicing.. <br />Software Version Installed. d tl1 t <br />Complete the followinz checklist- <br />In Section E belowi describe how -and when mese deucaences were or wsu -De eorrcecea. <br />c <br />E. Comments: /z &adwe <br />CALM -01 Page 2.of 3 _11A1 M - <br />❑ No* <br />Is the audible alarm operational? <br />❑ No* <br />Is the visual alarm operational? <br />O No* <br />Were all sensors visually inspected, functionally tested, and confirmed operational? <br />❑ No* <br />Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will <br />fyes <br />not interfere with their proper operation? <br />Cl No* <br />If alarms are relayed to a remota monitoring station, is all communications equipment (e.g. modem) <br />❑ N/A <br />operational? <br />❑ No* <br />For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment <br />A • <br />monitoring system detects a leak, fails to operate, -or is electrically disconnected? If yes: which sensors initiate <br />positive shut -down? (CheckaU Burt apply) Sumpifre nch Sensors; ❑ Dispenser Containment Sensors. <br />'Did you confirm positive shut -down due to leaks and sensor failurre(disconnection? #VYes; 0 No. <br />-0 Yes <br />❑ No* <br />For -tank systems that utilize: the monitoring system ' as- the prirhary tank -overfill warning device (Le- -no <br />IA <br />mechanical overfill preventiowvalye-is installeA is the overfill warning alarm visible and audible at the tank <br />l <br />fill points) and operating propdrly?,If so, at what•p=ent of tank -capacitydoes.the alarm trigger? <br />• 0 'Yes* <br />Igo <br />:Was any monitoring egWpment replaced? If yes. identify spwific sensors, probes, or -other equipment replaced - <br />and list the manufactur7er name and model for all replacement parts in Section E, below:. ., . <br />9PYet* <br />0 No'. <br />Was liquid, found inside any secondary containment systems designed as dry systems? (Check all that apply) <br />❑ Product; ater_: If yes, describe iu Section E; below , <br />' ❑ No* <br />Was monitoring system set�rp reviewed to ensure proper settings? . <br />Yes <br />❑ -No* <br />Is all monitoring equipment operational per mannfadrmees specifications? <br />In Section E belowi describe how -and when mese deucaences were or wsu -De eorrcecea. <br />c <br />E. Comments: /z &adwe <br />CALM -01 Page 2.of 3 _11A1 M - <br />