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i LIQUID • - FUNCTIONALITY TESTING 0 Facility Name: Owner. 3 m Address: Address: a City,State,Zip Code: City,State,Zip Code: v Facility I.D.#: Phone#: Testing Company. Phone#: Date: o it This procedure is to determine whether liquid sensors located in the interstitial space of UST systems are able to detect the presence of water and fuel.See PEVRP1200 7 CD Section 8.3 for the test procedure. Sensor Location M � 1 Product Stored a 11 Discriminating ❑Discriminating ❑Discriminating ❑Discriminating ❑Discriminating ❑Discriminating ❑Discriminating Type of Sensor ❑Non-discnmi- ❑Non-discrimi- ❑Non-discrimi- ❑Non•discrimi- ❑Non-discrimi- ❑Non-discrimi ❑Non-dlscrimi- d nating nating nating nating nating nating nating o Test Liquid ❑Water ❑Water ❑Water ❑Water ❑Water ❑Water ❑Water o ❑Product ❑Product ❑Product ❑Product ❑Product ❑Product ❑Product v Is the ATG console clear of any active 0 or recurring warnings or alarms regarding the leak sensor?If the ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No Dyes ❑No sensor is in alarm and functioning, indicate why. 0 Is the sensor alarm circuit ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No operational? !• 0 Has sensor been inspected and in ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No good operating condition. Q When placed in the test liquid,does ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No 0 the sensor trigger an alarm? a When an alarm is triggered,is the sensor properly identified on the ATG ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes O No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No 0 console? 9 d 5' Any"No"answers indicates the sensor fails the test. m Test Results ElPass 11Fail ❑Pass ❑Fail ❑Pass ❑Fait ❑Pass EJ Fail ElPass 11Fall ❑Pass ❑Fail ❑Pass ❑Fail n Comments: M c tG d Tester's Name(print) Tester's Signature ' I