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� ` ate of Tessin /Servicin <br />Site Address: `� �� l-✓ �i"le-e2�e�T`�'�-� L� _ D Testing/Servicing: <br />D. Results of Testing/Servicing <br />Software Version Installed: <br />k,om rete <br />the Buleuwtte <br />UUMI M. <br />Y <br />❑ No* <br />Is the audible alarm operational? <br />Ye <br />❑ No* <br />Is the visual alarm operational? <br />❑ No* <br />Were all sensors visuallyinspected, 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 />❑ 1o`-- <br />If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) <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 />❑ N/A <br />monitoring system detects a leak, fails to operate or is electrically disconn c . If yes: which sensors initiate <br />/Trencli Sensors; E Dispenser Containment Sensors. <br />positive shut -down? (Check all that apply) OiKu <br />Did you confirm positive shut -down due to leaks and sensor failure/disconnection? La -les; ❑ 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 />EKi/A <br />mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank <br />fillpoint(s) and operating ro erl ? If so, at what percent of tank capacity does the alarm trigger? 9MOIX <br />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 re lacetment 2arts in Section E, below. <br />❑ Yes* <br />OIN o <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 />.11 <br />s <br />❑ No* <br />Was monitoring system set-up reviewed to ensure proper settings? <br />Yes <br />❑ No* <br />1 Is all monitorin a ui mentoperational per manufacturer's specifications? <br />* In Section E below, describe how and when these deficiencies were or win oe correcteu. <br />E. Comments: q/ 00 �•-a,>o %� z <br />Page 2 of 3 03101 <br />