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UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page a of s) V111 . MONITORING SYSTEM AND PROGRAMMING This section must be completed if a monitoring panel Is used to perform leak detection monitoring. YrEn NA Are the visual and audible alarms operational? X❑Were all sensors visually inspected for kinks and breaks in the cables and for residual buildup to ensure that floats move freely, Qfunctional) tested . and confirmed o erational? Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with0 ❑their ro er o eration?Was monitoring system set-up reviewed to ensure proper settings? ❑X 1 El Was the monitoring panel's backup battery visually inspected , functionally tested , and confirmed operational? X❑ ❑ ❑ Does the now of fuel stop at the dispenser if a leak is detected in the under4spenser containment? X❑ ❑ ❑ Does the turbine automatically shut down if the piping secondary containment monitoring system fails to operate or is electrically O ❑ ❑ 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. ) 0 Sump X❑ Under-Dispenser Containment If alarms are relayed to a remote monitoring station, is all communications equipment (e.g , modem) operational? Q ❑ ❑ For any answer of "N" above, describe in Section IX how and when these deficiencies were or will be corrected. IX . COMMENTS X. INJANK 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 ln-tankqauglng is used to perform leak detection monitoring. Has all input Wring been inspected for kinks and breaks in the cables and for proper entry and termination , including testing for Q ❑ ❑ round faults? Were all in-lank gauging probes visually inspected for damage and residue buildup to ensure that floats move freely functionally x r 1 ❑ tested , and confirmed operational? u Was accuracy of system's product level readings tested? ❑ ❑ Was accuracy of system's water level readings tested? ❑ 1 ❑ Were all probes reinstalled properly? ❑ ❑ Were all items on the equipment manufacturer's maintenance checklist completed? ❑X ❑ ❑ 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