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Momtpring System Certification <br /> Site Address: <br /> l �(�//� � Date of Testing/Servicing: <br /> �. � �/�e'/�-- ���' <br /> D. Results of Testing/Servicing` / <br /> Software Version Installed: / d / <br /> Complete the following checklist: <br /> Yes ❑ No* Is the audible alarm operational? <br /> Yes CP.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 <br /> not interfere with their proper operation? ' <br /> ❑ Yes ❑ No* If alas are relayed to a remote monitoring station, is all communications equipment (e.g. modem) <br /> alarms <br /> 23'N/A operational? <br /> ® Yes ❑ No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment <br /> NIA monitoring system detects a leak, fails to operate,or is electrically disconnected? If yes: which sensors initiate <br /> positive shut-down? (Check all that apply) E-4-Sump/Trench Sensors; ❑Dispenser Containment Sensors. <br /> Did you confirm positive shut-down due to leaks and sensor failure/disconnection? &Yes; ❑No. <br /> ❑ yes ❑ No* For tank systems that utilize the monitoring system as the primary tarrl: overfill warning device (i.e. no <br /> Cij N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank <br /> fill point(s)and operating properly? If so,at what percent of tank capacity does the alarm trigger? % <br /> ❑ Yes* No' 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 /> ❑ Yes* No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) <br /> ❑ Product; ❑Water. If yes,describe causes in Section E,below. <br /> P1 Yes ❑ No* Was monitoring system set-up reviewed to ensure proper settings? <br /> Yes ❑ I\'o* Is all monitoring equipment operational per manufacturer's specifications? <br /> *In Section E below,describe how and when these deficiencies were or will be corrected. <br /> E. Comments: <br /> t�I✓/l t?✓� /`� /! � 2 d 1"� 9 /�l l !/ t�%L S 1>it/,SdYI_ 1/ O <br /> CALM-01G <br /> Page2of3 it/r= <br />