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Monitoring System Certification 9 0 <br />Site Address: 110 W. Turner Rd. <br />Software Version Installed: 127.04 <br />Complete the following checklist: <br />Date of Testing/Servicing: 1/28/08 <br />0 Yes <br />0 No* <br />Is the audible alarm 2perational? <br />0 Yes <br />❑ No* <br />Is the visual alarm operational? <br />0 Yes <br />E] No* <br />Were all sensors visually inspected, functionally tested, and confirmed operational? <br />(D Yes <br />0 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 22eration? <br />0 Yes <br />0 No* <br />If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) <br />0 N/A <br />operational? <br />n Yes <br />[I No* <br />For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment <br />ED N/A <br />monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate <br />I <br />positive shut -down? ( <br />Check all that apply) [I Sump/Trench Sensors; 0 Dispenser Containment Sensors. <br />Did you confirm positive shut -down due to leaks and sensor failure/disconnection? [I Yes; [I No. <br />[D Yes <br />0 No* <br />For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no <br />0 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 />0 Yes* <br />E] 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 />D Product; 0 Water. If yes, describe causes in Section E, below. <br />0 Yes <br />El No* <br />Was Monitoring system sq -u reviewed to ensure proper settings? <br />0 Yes <br />0 No* <br />Is all mon!!2rig N!iEmento perational per manufacturer's 2ecifications? <br />* In Section E below, describe how and when these deficiencies were or will be corrected. <br />E. Comments: <br />TLS -300 WAS REPLACED WITH A TLS -350 PLUS <br />L3- NORTH SUMP- TANK GAUGE — 794380-208 <br />L4- PIPING TRENCH — 794390-420 <br />Page 2 of 3 <br />