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UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM ( Page 4 of 6 ) 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? ❑X ❑ ❑ 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 FX1 ❑ ❑ their proper operation ? Was monitoring system set-up reviewed to ensure proper settings ? ❑X ❑ ❑ Was the monitoring panel's backup battery visually inspected , functionally tested , and confirmed operational ? X❑ ❑ ❑ Does the flow of fuel stop at the dispenser if a leak is detected in the under-dispenser containment? ❑X ❑ ❑ Does the turbine automatically shut down if the piping secondary containment monitoring system fails to operate or is electrically ❑ ❑ disconnected ? FX 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.) XSump ❑ Under- Dispenser Containment ❑ F] ❑ If alarms are relayed to a remote monitoring station , is all communications equipment (e . g . , modem) operational ? ❑ ❑ ❑X For any answer of "N" above, describe in Section /X how and when these deficiencies were or will be corrected. IX . COMMENTS Dispensers 1 -8 have floats and chains . Found 91 #1 sump sensor not in the lowest point. It was repositioned by the technician and is now at the lowest point . X . IN -TANK GAUGING TESTING XCheck 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 ❑ ❑ ❑ round 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 ? ❑ ❑ ❑ Was accuracy of system' s water level readings tested ? ❑ ❑ ❑ Were all probes reinstalled properly? ❑ ❑ ❑ 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 deficiencies were or will be corrected. XL COMMENTS Y = Yes, N = No, NA = Not Applicable UN -107 www, unidoes . org 4/6 - Rev. 10/01 /18