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Software Version Installed: <br />Complete the following checklist: <br />Yes ❑ \o* <br />Is the audible alarm operational? i <br />l'Yes ❑ \o* <br />Is the visual alarm operational? <br />❑_Yes_ _te�No* _ <br />Were 211, sensor_v_isually inspected. functionally tested. and confi..,er ooerationai? € <br />C3��'es I ❑ \o* <br />Were a'.'. sensors installed at lowest point of secondar; contail-ner.: and positioned so that other equipment will ' <br />not inset ere with their proper operation" <br />El Yes ❑ \o* <br />If alar. -.are relayed to a remote monitoring station, is all communications equipment (e.g. modem) <br />&-N/A <br />operational? <br />i <br />❑ Yes 2"\o* <br />For pressurized piping systems, does the turbine automatically shut do•.«t if the piping secondary containment <br />I ❑ N/A <br />monitoring system detects a leak, fails to operate, or is electrically ds:oanected? If yes: which sensors initiate <br />positive scut-do«n? (Check all that apph) ❑ Sump 7rench Sensors: :1 Dispenser Containment Sensors. I <br />Did you confirm positive shut-do%,,•n due to leaks and sensor failure dsconnection? ❑ Yes; ❑ No. p <br />❑ Yes ❑ No* <br />For ta.>: systems that utilize the monitoring system. as the prima.-- tank overfill warning device (i.e. no <br />Q�\L� <br />mechani:al overfill prevention valve is installed), is the overfill wam-i c alarm visible and audible at the tank <br />i <br />fill oi:iti s) and operating properly? If so, at what percent of tank ca-�a:iry does the alarm trigger? % i <br />❑ Yes* o <br />Wes anv monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced <br />and list :he manufacturer name and model for all replacement parts is Section E below. �1 <br />❑ Yes* ❑ do <br />I <br />Was liquid found i,-iside any secondary containment systems designed as dry systems? (Check all that apph) 1 <br />i <br />❑ Produ:r. ❑ Water. If ves, describe causes in Section E. below. <br />Yes ❑ \o* <br />Was monitoring system set-up reviewed to ensure proper settings? A-a:h set up reports. if applicable <br />I ❑ Yes 2' No* <br />Is all mo nitorimg equipment oerational per manufacturer's s ecifca:ions? <br />. 111 Oecuuu r, oeiow, aescrtoe now ana wnen inese aeuctenctes were or will be corrected. <br />E. Comments: -r(-( 4v o`/L a Z t2 ALAI cocc / 7 /NUS 'A3�r <br />?-H� ��C�Lii`Lc�lJ �JD G Uc 74 GooC�� &O T 42,F `t 4 c C4 �- 5 <br />c i i� V�.r 4 k D h SZ�a 4-4-4 4C- Ca V —Ie- JZ -O <br />,44_" W 7—,CS ! � `r� /�2E�f �r c c 4 �� lG % Ti�r7—�+✓� e rte ;� r� �� w c 7'- <br />4f.c.,v.e_T P zC -O l <br />-h'O r> 121.AL 13 rx: / <br />Page 3 of 3 <br />03/0I <br />