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UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM III. MONITORING SYSTEM AND PROGRAMMING This section must be completed if a monitoring panel is used to perform leak detection monitoring. Y N N/A Are the visual and audible alarms operational? ® ❑ ❑ Were all sensors visually inspected for kinks and breaks in the cables and for residual buildup to ensure that floats ® ❑ ❑ move freely,functionality tested,and confirmed operational? 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? ® ❑ ❑ Was the monitoring panel's backup battery visually inspected,functionality tested,and confirmed operational? ® ❑ Does the flow if fuel stop at the dispenser if a leak is detected in the under-dispenser containment? ❑ ❑ 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? ® ❑ ❑ Which sensors initiate positive shut down?(Check all that apply) ® sump ® Under-Dispenser Containment If alarms are relayed to a remote monitoring station,is all communications equipment(e.g.,modem)operational? ❑ ❑ For any answer of"N"above,describe in Section IX how and when these deficiencies were or will be corrected. IV. COMMENTS V. IN-TANK GAUGING TESTING ® 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 N/A 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 ground faults? Were all in-tank gauging probes visually inspected for damage and residue build up to ensure that floats move ❑ ❑ ❑ freely,functionally tested,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? El 1 El For any answer of"N'above,describe In Section X1 how and when these deficiencies were or will be corrected. VI. COMMENTS