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SIEMENS i!lliiiiii UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page 4 of 6) VIII . MONITORING SYSTEM AND PROGRAMMING This section must be completed if a monitoring panel is used to perform leak detection monitoring. Y N NA Are the visual and audible alarms operational? Q ❑ ❑ Were all sensors visually inspected for kinks and breaks in the cables and for residual buildup to ensure that floats move freely, El 1:1functional) tested , and confirmed operational ? 19 Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with El El proper operation? 19 Was monitoring system set-up reviewed to ensure proper settings? 0 ❑ El Was the monitoring panel 's backup battery visually inspected , functionally tested , and confirmed operational ? Q ❑ ❑ Does the flow of fuel stop at the dispenser if a leak is detected in the under-dispenser containment? Q ❑ ❑ Does the turbine automatically shut down if the piping secondary containment monitoring system fails to operate or is electrically 1:11:1disconnected ? Does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak? IM ❑ ❑ Which sensors initiate positive shut down ? (Check all that apply.) ❑X Sump Q Under-Dispenser Containment If alarms are relayed to a remote monitoring station , is all communications equipment (e .g . , modem) operational ? Q ❑ ❑ For any answer of "N" above, describe in Section IX how and when these deficiencies were or will be corrected. IX. COMMENTS X. IN -TANK GAUGING TESTING ❑X Check this box if tank gauging is used only for inventory control . (Do not complete this section.) ❑ Check this box if NO tank gauging equipment is installed . (Do not complete this section.) Y N NA This section must be completed if in-tank gauging is used to perform leak detection monitoring. Has all input wiring been inspected for kinks and breaks in the cables and for proper entry and termination , including testing for 1:1 ❑ round faults? Were all in-tank gauging probes visually inspected for damage and residue buildup to ensure that floats move freely, functionally ❑ El 1:1tested , and confirmed operational ? Was accuracy of system's product level readings tested? ❑ ❑ ❑ Was accuracy of system's water level readings tested ? ❑ ❑ ❑ Were all probes reinstalled properly? ❑ ❑ ❑ Were all items on the equipment manufacturer's maintenance checklist completed ? ❑ ❑ ❑ For any answer of "N" above, describe in Section XI how and when these deficiencies were or will be corrected. XI . COMMENTS Y = Yes, N = No, NA = Not Applicable