Form 6-2 Operational Checklist: Pump: Demand-dosed system (PDD) (Including siphons)

Service provided on: Date: Service provided by: Company: Date of last service: Date of last inspection: System type: "# !ump Siphon Time: Reference #: Employee: By: You Other: NOTES

"# )cceptable Controls /nacceptable a# Type: !i$$y bac% Control panel b# Controls operatin$ properly# Yes &o c# 's enclosure (aterti$ht# Yes &o d# )larm test s(itch (or%in$ properly# Yes &o e# )t time of inspection* control s(itch +,)&D-O..-)/TO0 (as set at: 1,and23anual4 1)uto4 1Off4 f# Electrical meter readin$s: Readin$ +this0 Readin$ +last0 Difference &#)# i0 ET3 min ii0 Cycles2events Events +&C0 Calculate cycles2day: 5&C6 2 5Days6 7 5C!D6 $# Telemetry operational# &#)#: Yes &o Type: 8# !ump2Siphon 8# )cceptable a# Siphon operatin$ properly# &#)#: Yes &o /nacceptable b# !ump operatin$ properly# Yes &o c# Type of pump: 3ulti-sta$e Sin$le-sta$e d# )mps measured: amps e# 9olta$e measured: volts f# !ump turns on2turns off# Yes &o :# )cceptable :# ;ater level sensors /nacceptable a# Type of (ater level sensor: .loats !ressure transducers /ltrasonic Other: b# !ump floats2sensors functionin$ properly# Yes &o c# )larm float2sensor operatin$ both audible and visible# Yes &o <# Sensor settin$s: Sensor .unction Operational Set )t== Secured &umber= 'nches Datum " Yes &o Yes &o 8 Yes &o Yes &o : Yes &o Yes &o < Yes &o Yes &o > Yes &o Yes &o *(Designate starting from bottom of tank) ** (Measurements are taken from a fixed point (Datum) near the surface or bottom of float tree in inches) ># Dose volume +D90 a# !ump Off ? !ump On 7 in pumped +dose0 b# @!': +.orm A#" ? 'tem :#e0 dose +in0 B @!' 7 D9+$al0

Reference #: A# !ump delivery rate +!DR0 a# Dose volume +from 'tem >0: b# 9erified pump run time 1On4: $al pumped C min 7 Total $allons a# 3ethod to activate pump: ;ater added Eifted float b# Total $allons +from elapsed time meter0 5 +!TR0 +ETR06 B +@!30 7 Total @al OR Total $allons +from event2cycle counter0 5 +!CR0 +ECR06 B +D90 7 Total @al @allons per day +@!D0 a# Total $al &o# of days 7 @al2day +@!D0 $al min @!3

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F#

C!D: Cycles per day D9: dose volume ET3: Elapsed time meter @!': $allons per inch @!3: $allons per minute @!D: $allons per day ,)&D-O..-)/TO: ,and-Off-)uto S(itch ECR: last cycle readin$ ETR: last time readin$ !CR: present cycle readin$ !DR: pump delivery rate !TR: present time readin$