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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page 4 of s) <br /> Villa MONITORING SYSTEM AND PROGRAMMING <br /> This section must be completed if a monitoring panel is used to perform leak detection monitoring. Y N NA ~ <br /> Are the visual and audible alarms operational? © Q <br /> El <br /> Were all sensors visually inspected for kinks and breaks in the cables and for residual buildup to ensure that floats move freely, <br /> functionally tested , and confirmed operational? <br /> Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with <br /> their proper operation? V El EJ <br /> Was monitoring system set-up reviewed to ensure proper settings? ® Q F1 <br /> Was the monitoring panel's backup battery visually inspected , functionally tested, and confirmed operational? W1 El <br /> Does the flow of fuel stop at the dispenser if a leak is detected in the under-dispenser containment? ©L Q <br /> Does the turbine automatically shut down if the piping secondary containment monitoring system fails to operate or is electrically <br /> disconnected? Z El El <br /> Does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak? El El <br /> sensors initiate positive shut down? (Check all that apply.) � Sump � Under-Dispenser Containment <br /> If alarms are relayed to a remote monitoring station, is all communications equipment (e .g. , modem) operational? Q <br /> For any answer of `W" above, describe in Section IX how and when these deficiencies were or will be corrected. <br /> IX. COMMENTS <br /> Replaced TLS Battery for PM Purpose . <br /> X . IN-TANK GAUGING TESTING <br /> Check this box if tank gauging is used only for inventory control. (Do not complete this section) <br /> ❑ Check this box if NO tank gauging equipment is installed. (Do not complete this section.) Y N NA <br /> This section must be completed if in-tank gauging is used to perform leak detection monitoring, <br /> Has all input wiring been inspected for kinks and breaks in the cables and for proper entry and termination , including testing for <br /> round faults? El <br /> Were all in-tank gauging probes visually inspected for damage and residue buildup to ensure that floats move freely, functionally <br /> tested, and confirmed operational? <br /> Was accuracy of system's product level readings tested ? El <br /> Was accuracy of system's water level readings tested? 1:1 El <br /> Were all probes reinstalled properly? D <br /> Were all items on the equipment manufacturer's maintenance checklist completed? ❑ I El I El <br /> For any answer of "M' above, describe in Section Xl how and when these deficiencies were or will be corrected. <br /> XI . COMMENTS <br /> Y = Yes, N = No, NA = Not Applicable <br /> f <br /> i <br /> i <br /> i <br /> i <br />