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lUL 2020 UNDERGROUND STORAGE TANKi fl f1,'i I' : . 1 E F Y` ; W w MONITORING SYSTEM CERTIFICATION FORM (Page a of 6 Ville 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? ro Were all sensors visually inspected for kinks and breaks in the cables and for residual buildup to ensure that floats move freely,functional) tested and confirmed o erational? Were ail sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their ® ❑ ro r o eration? 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? ❑ ❑ For any answer of "N" above describe in section Mhow and when these deBclencles were or will be corrected. IX. COMMENTS UDC and STP sensors initiate positive shutdown X. IWTANK GAUGING TESTING ID 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 fn-tank gauging is used to perfonn leak detection monitorin . 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, r 11 and confirmed operational? Was accuracy of system's product level readings tested? 11 11Was accuracy of system's water level readings tested? ❑ 11Were ail probes reinstalled properly? ❑ ❑ Were all items on the equipment manufacturer's maintenance checklist completed? ❑ RffFo For any answer of "N" above describe in section XI how and when these deficiencies were or will be corrected. XI. COMMENTS E l j Y = Yac N a Nn NA a Nnf Anr41mt 4+