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Monitoring System Certification r <br />,� Date of Testmg/Servicing�e <br />Site Address: __.�__ � <br />D. Results of Testing/Servicing <br />Software Version Installed: <br />gCoetethe following checklist:❑ No* Is the audible alarm operational? <br />❑ No* Is the visual alarm operation❑ 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 alarms are relayed to a remote. monitoring station, is all communications equipment (e.g. modem) <br />❑ N/A operational? <br />lyes O No* For pressurized piping systems, does the turbine automatically shut down .if the piping secondary containment <br />$ em detects a leak, fails to operat electrically disconnected? If yes: which sensois initiate <br />' Q • N/A monitoring cyst . <br />positive shut -down? (Check all that apply) Sump/Trench Sensors; ❑ Dispenser Containment Sensors. <br />Lryes,"Did you confirm positive shut -down due to leaks and sensor failure/disconnection?. ❑ No. <br />.Yes ❑ No* For tank systems that utilize the' monitoring system as the prithary tank overfill warning device (i.e. no <br />= ❑ .NIA mechanical overfill prevention -valve is installed), is the overfill warning alarm visible and audible the tank <br />fill point(s) and operating property? . If so, at what percent of tank capacity does the alarm trigger? �o <br />meant laced?. If . identify specific sensors, probes, or -other equipment replaced <br />Yes* ❑ No `Was any monitoring equip rep y� <br />and list the manufacturer name and model for all replacement parts in Section 1y below. <br />' O Y No Was liquid found inside any secondary containment.sjrstems designed as dry systems? (Check all that apply)' <br />j ❑ pwduc4 .0 Water. If yes, describe causes in Section I:, below. <br />Yes ❑ Was on <br />system set-up review <br />ed.to ensure proper settings? . <br />Is all monito mento onal manufacturer's specifications? <br />LEY <br />es No* � WAP pin � .. <br />* In. Section E belowi describe how -and when these deficiencies were or will be corrected- <br />E. Comments - <br />CALM -01 <br />Page 2.of 3 - � 1Ut5l94 <br />