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UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page 4 of 6) WIN 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 ? 0 ❑ ❑ Were all sensors visually inspected for kinks and breaks in the cables and for residual buildup to ensure that floats move freely, 0 ❑ ❑ 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 0 ❑ ❑ 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? Q ❑ ❑ Does the flow of fuel stop at the dispenser if a leak is detected in the under-dispenser containment? ❑X ❑ El Does the turbine automatically shut down if the piping secondary containment monitoring system fails to operate or is electrically ❑X ❑ Eldisconnected ? 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) ❑X Sump X❑ Under-Dispenser Containment XEl El If alarms are relayed to a remote monitoring station , is all communications equipment (e .g . , modem) operational? ❑ 0 For any answer of W' above, describe in Section IX how and when these deficiencies were or will be corrected. IX. 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 ❑ ❑ round faults? Were all in-tank gauging probes visually inspected for damage and residue buildup to ensure that floats move freely, functionally FX1 ❑ ❑ tested , and confirmed operational? Was accuracy of system's product level readings tested? ❑X ❑ ❑ Was accuracy of system's water level readings tested ? ❑X ❑ ❑ Were all probes reinstalled properly? ❑X El El Were all items on the equipment manufacturer's maintenance checklist completed ? ❑X ❑ ❑ For any answer of "M' above, describe in Section Xi how and when these deficiencies were or will be corrected. XI . COMMENTS I Y = Yes, N = No, NA = Not Applicable f