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UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page a 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, ❑X ❑ ❑ functionally tested , and confirmed operational? Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with FX] ❑ ❑ their proper operation? Was monitoring system set-up reviewed to ensure proper settings? Q ❑ ❑ Was the monitoring panel's backup battery visually inspected , functionally tested , and confirmed operational? X❑ ❑ ❑ 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 ❑ ❑X ❑ disconnected? Does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak? ❑ X ❑ 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? ❑ ❑ 0 For any answer of "N" above, describe in Section IX how and when these deficiencies were or will be corrected. IX . COMMENTS SITE PERFORMS LINE TEST EVERY YEAR DUE TO NON SHUTDOWN i 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 ❑ ❑ ❑ round faults? Were all in-tank gauging probes visually inspected for damage and residue buildup to ensure that floats move freely, functionallyEl ❑ ❑ tested , and confirmed operational? sWas 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