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UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page a of s) VIII . 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 7 ❑ ❑ :1 their proper operation? Was monitoring system set-up reviewed to ensure proper settings? ® ❑ I ❑ Was the monitoring panel's backup battery visually inspected , functionally tested , and confirmed operational? ® El I ❑ 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? W3 El 11 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? 1 ❑ ❑ 0 For any answer of "N" above, describe in Section IX how and when these deficiencies were or will be corrected. IX. COMMENTS Replaced TLS Battery for PM Purpose . 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 Vuging 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 ❑ ❑ ❑ round faults? Were all in-tank gauging probes visually inspected for damage and residue buildup to ensure that floats move freely , functionallyFEl ❑ 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? ❑ ❑ I ❑ Were all items on the equipment manufacturer's maintenance checklist completed? ❑ ❑ ❑ ' For any answer of "N" above, describe in Section X1 how and when these deficiencies were or will be corrected. XI . COMMENTS t Y = Yes, N = No, NA = Not Applicable `r f