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06 / 28 / 2019 19 : 29 8387674 EMILS PAGE 22 <br /> UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM jPage4 of 6 <br /> VIII . MONITORING SYSTEM AND PROGRAMMING <br /> This section must be completed if a monhoring panel is used to perform leak datection monkoring- �fY N NA <br /> Are the Visual and audible alarms operational? <^1 _ _❑ <br /> Were all sensors visually inspected for kinks and breaks in the cables and for residual buildup to ensure that floats move freely, ❑X ❑ ❑ <br /> funetlonall tested and confirmed operational? <br /> Were all sensory installed at lowest point of secondary cofltainment and posiooned so that other equipment will not interfere with 0 j ❑ ❑ <br /> their ro er o eration7 <br /> Wes monitoring System set-up reviewCd io ensure proper settings? <br /> Q El <br /> Was the monitoring panel's backup battery visually Inspected , functionally tested , and confirmed operational? QEl ❑ <br /> Does the flow of fuel stop at the dispenser If a leak is detected in the under-dispenser writalhment , X❑ 1 ❑ ❑ <br /> Does the turbine automatically shut down if the piping secondary containment monitoring system falls to operate or is electrically D ❑ ❑ <br /> disconnected ? <br /> Does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak? 9 I EJ <br /> ❑ <br /> Mitch sensors initiate positive shut down? (Check all that apply.) N Sump ElC <br /> Under-Dispenser anteihmsnt <br /> If alarms are relayed to a remote monitoring station , ie all communications equipment (e.g „ modem) operational? ❑ ❑X <br /> For any answer of "N " above, describe in Section IX how and when these deficiencies were or will be corrected <br /> IX. COMMENTS <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 inwtankqauging is used to perform lank detection monitoring. <br /> Was all input wiring been Inspected for kinks and breaks In the cables and for proper entry and germination , Including testing for ❑ El <br /> founcl faults? — <br /> Wcre ail in-tank gauging probes visually Inspected for damage and residue buildup to ensure that floats move freely, functionallyFzX El <br /> tested and confirmed operational? F] <br /> Was accuracy of system' s product level readings tested? 9 ❑ <br /> 1 0 <br /> Was accuracy of system's water level readings tested? X I ❑ 1 ❑ <br /> Were all probes reinstalled properly? ❑ <br /> Were all items on the equipment manufacturer's maintenance checklist Completed ? ❑X ❑ <br /> For any answer of `rN" above, describe in Section XI how and when these deficiencies wero or will be corrected. <br /> XI . COMMENTS <br /> I - <br /> Y = Yes, N No. NA d Not Applicable <br /> Received Time Jun , 28 , 2019 7127PM No , 5223 <br />