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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 perfonn leak detection monitoring. Y N NA 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, ❑ ❑ 01 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 their ❑ ❑ proper operation? Was monitoring system set-up reviewed to ensure proper settings? ® ❑ ❑ Was the monitoring panel's backup battery visually Inspected, functionally tested, and confirmed operational? ® ❑ ❑ Does the flow of 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? © ❑ In Foran answer of 'W" aboyes describe In section W how and when these deficiencies were or will be corrected. IX. COMMENTS The 91 annular sensor was replaced due to failure during the Monitoring Certification on 6/14/2019 The 91 annular sensor was replaced 'like for like " Model 794390409 Serial # 1374554 The 91 annular sensor activated an audible and visual alarm when tested X. 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 NA This section must be com l*ted if in tank gauging Is used to peribrin leak detection monitodn . 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 buildup 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? ❑ ❑ ❑ For anv answer of "N" above describe in section XI how and when these deficiencies were or will be corrected XI. COMMENTS V - VPQ N Nn NA a Nnt Amir=Na