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UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page 4 of 6) VI11 . 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 F]functional) 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 ❑ their proper operation? Was monitoring system set-up reviewed to ensure proper settings ? Q 1:1 ❑ Was the monitoring panel's backup battery visually inspected , functionally tested , and confirmed operational? Q Q ❑ Does the flow of fuel stop at the dispenser if a leak is detected in the under-dispenser containment? 0 ❑ ❑ Does the turbine automatically shut down if the piping secondary containment monitoring system fails to operate or is electrically ❑ ❑ disconnected ? Does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak? 0 ❑ ❑ Which sensors initiate positive shut down? (Check all that apply) ❑ sump ❑X Under-Dispenser Containment If alarms are relayed to a remote monitoring station, is all communications equipment (e. g . , modem) operational? ❑ El 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 El ❑ ❑ round faults? Were all in-tank gauging probes visually inspected for damage and residue buildup to ensure that floats move freely, functionally El 1:1 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? ❑ 1 ❑ 1 ❑ Were all items on the equipment manufacturer's maintenance checklist completed ? ❑ I ❑ I ❑ For any answer of "N" above, describe in Section Xl how and when these deficiencies were or will be corrected. XI . COMMENTS Y = Yes, N = No, NA = Not Applicable