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Site Address 1469 E HAMMER LANE <br />D. Results of Testing/Servicing <br />Software Version Installed: 119.02 <br />Complete the following checklist: <br />nitoring System Certification <br />Date of Testing/Service: <br />10/20/2008 <br />XYes <br />❑ No * <br />Is the audible alarm operational? <br />Q Yes <br />11No* <br />Is the visual alarm operational? <br />Q Yes <br />No * <br />Were all sensors visually inspected, functionally tested, and confirmed operational? <br />0 Yes <br />❑ No * <br />Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not <br />interfere with their proper operation? <br />Yes <br />n No* <br />X N/A <br />If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? <br />❑ Yes <br />❑ No * <br />❑X N/A <br />For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment <br />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 to leaks and sensor failure/disconnection? ❑ Yes ❑ No <br />❑ Yes <br />❑ No* <br />❑X N/A <br />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 />❑ Yes* <br />❑X No <br />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* <br />❑X No <br />Was liquid found inside any secondary containment systems designed as dry systems? (check all that apply) ❑ Product; <br />❑ Water. If yes, describe causes in Section E, below. <br />❑X Yes <br />❑ No * <br />Was monitoring system set-up reviewed to ensure proper settings? Attach set-up reports, if applicable. <br />0 Yes <br />❑ No * <br />Is all monitoring equipment operational per manufacturers' specifications? <br />* In Section E below, describe how and when these deficiences were or will be corrected. <br />E. Comments: <br />TESTEDONLY 1 ANNULAR SENSOR. <br />Page 2 of 3 Based on CA form dated 03/01 <br />