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GEMER-RYAN lic. 0 GR.JobA 20-631615 <br /> ECEIVEE, <br /> D. Re6uits of Testing/Servicing <br /> Software Version Installed: 333.05 AUG 14 2015 <br /> Complete the following checklist: ENVIRONMEN <br /> g Yes [3 NO* is the audible alarm operational? A r-N I <br /> rg Yes [3 No* is the visual alarm operational? <br /> rx Yes 13 Ne Were all sensors visually Inspected,functionally tested,and confirmed operational? <br /> ff Yes [3 No- Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their <br /> proper operation? <br /> (I Yes 13 No- If alarms are relayed to a remote monitoring station,is all communication equipment(e.g.modem)operational <br /> 0 NIA I <br /> rA- Yes 13 No* For pressurized piping systems,does the turbine automatically shut down if the piping secondary containment monitoring system <br /> [3 N/A detects a leak,fails to operate,or is electrically disconnected?If yes:which sensors initiate positive shut-down?(Check all that apply) <br /> 11A Sumprrrench Sensor ra Dispenser Containment Sensor.Did you confirm positive shut-down due to leaks and sensor <br /> failure/disconnection? rX Yes; 13 No. <br /> 11 Yes [3 No- For tank systems that utilize the monitoring system as the primary tank overfill warning device(;.e.no mechanical overfill prevention <br /> [3 N/A valve is installed),is the overfill warning alarm visible and audible at the tank fill point(s)and operating property?If so,at what percent <br /> of tank capacity does the alarm trigger? 10_% <br /> Ej Yes [3 No Was any monitoring equipment replaced?If yes,identify specific sensors,probes,or other equipment replaced and list the <br /> manufacturer name and model for all replacement its in Section E,below. <br /> [3 Yes [j No Was liquid found inside any secondary containment systems designed as dry systems?(Check all that apply) 13 Product OWater. if <br /> yes,describe causes in Section E,below. <br /> E Yes [3 NF— Was monitoring system set-up reviewed to insure proper settings?Attach set-up reports,if applicable. <br /> g Yes 1 13 No- I Is all monitoring equipment operational per manufactures specifications? <br /> In Section E below,describe how and when these deficiencies were or will be corrected. <br /> E. Comments: <br /> Replaced all annular sensors on site Three veeder root 409 sensors <br /> Monitoring System Certification Page 2 of 4 12107 <br /> 2 <br />