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UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page 4 of 6 VIU, 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? ® ❑ ❑ Were all sensors visually inspected for kinks and breaks in the cables and for residual buildup to ensure that floats move freely, ® ❑ ❑ 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 under4spenser 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? ❑ ❑ Foran answer of "N" above describe In section W how and when these deficiencies were or will be corrected. We COMMENTS 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 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 buildup to ensure that floats move freely, functionally tested, ❑ ❑ ❑ and confirmed operational? Was accuracy of system's product level readings tested? 01 ❑ ❑ Was accuracy of system's water level readings tested? ❑ ❑ ❑ Were all probes reinstalled properly? 01 ❑ 1 ❑ E Were all items on the equipment manufacturer's maintenance checklist completed? ❑ ❑ [1 For any answer of "N" above describe in section Xi how and when these deSciencies were or will be corrected. XI. COMMENTS c V a Yam N Nn NO a Nnt Onr&taNa