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I <br />Monitoring System Certification <br />A Results of Testing/Servicing <br />Software Version Installed: <br />r1—.1ota tho fnlinwinrc n600lilict- <br />es <br />❑ No* <br />Is the audible alarm operational? <br />Yes <br />❑ No* <br />Is the visual alarm operational? <br />9 Yes <br />❑ No* <br />Were all sensors visually inspected, functionally tested, and confirmed operational? <br />..Yes <br />❑ No* <br />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 <br />❑ No* <br />If alarms are relayed to a remote monitoring station, is all communications equipment (e.g., modern) <br />% N/A <br />operational? <br />❑ Yes <br />❑ No* <br />For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment <br />jK N/A <br />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) ❑ Sump/Treneb Sensors; ❑ Dispenser Containment Sensors. <br />Did you confirm positive shut -down due to leaks and sensor failureldisconnection? ❑ Yes; ❑ No. <br />❑ Yes <br />❑ No* <br />For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no <br />5Z N/A <br />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 />)5 Yes* <br />❑ No <br />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* <br />0 No <br />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 />❑ Yes <br />❑ No* <br />Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable <br />❑ Yes <br />❑ No* <br />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 />L. Comments: <br />F] <br />UN -036-3/6 www.un idoes.org Rev. 01/17/08 <br />