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t 1 <br /> Monitoring System Certification-Page 2 of 3 <br /> Site Address: 6633 Pacific Ave Date of Testing/Servicing <br /> D. Results of Testing/Servicing <br /> Software Version Installed• <br /> Com lets the foll ing checklist: <br /> ❑ Yes ❑ No* Is the audible alarm operational? <br /> ❑ Yes ❑ No* Is the visual alarm operational? <br /> ❑ Yes ❑ No* Were all sensors visually inspected,functionally tested,and confirmed op 'onal? <br /> ❑ Yes ❑ No* Were all sensors installed at lowest point of secondary containment and sitioned so that other equipment will <br /> not interfere with their pLojer operation? <br /> ❑ Yes ❑ No* If alarms are relayed to a remote monitoring station, is all comm ions equipment(e.g.modem) <br /> ❑ N/A operational? <br /> ❑ Yes ❑ No* For pressurized piping systems,does the turbine automatically shut down if the piping secondary containment <br /> ❑ N/A monitoring system detects a leak,fails to operate,or is eleOically disconnected? If yes:which sensors initiate <br /> positive shut-down? (Check all that apply) ❑ Sump/Tp6nch Sensors; ❑ Dispenser Containment Sensors. <br /> Did you confirm positive shut-down due to leaks and p6nsor failure/disconnection? D Yes ❑ No <br /> ❑ Yes ❑ No* For tank systems that utilize the monitoring system the primary tank overfill warning device(i.e.no <br /> ❑ N/A mechanical overfill prevention valve is installed) s the overfill warning alarm visible and audible at the tank <br /> fill int(s)and operating ro r ? If so,at;,Z percent of tank ca aci does the alarm trigger? % <br /> ❑ Yes* ❑ No Was any monitoring equipment replaced?If es,identify specific sensors,probes,or other equipment replaced <br /> and list the manufacturer name and model r all replacement parts in Section E,below. <br /> ❑ Yes* ❑ No Was liquid found inside any secondary , ntainment systems designed as dry systems? (Check all that apply) <br /> ❑ Product;❑ Water. If yes,describe gauses in Section E,below. <br /> ❑ Yes ❑ No* Was monitoring em set-up review6d to ensurepro er settin s? Attach set-up reports, i a licable. <br /> ❑ Yes ❑ No* Is all monitoring equipment opera' nal per manufacturer's specifications? <br /> *In Section E below,describe how and when then deficiencies were or will be corrected. <br /> E. Comments: <br /> i <br />