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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? ® ❑ ❑ 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 their ® ❑ ❑ proper operation? Was monitoring system set-up reviewed to ensure proper settings? ® ❑ ❑ Was the monitoring panel's backup battery visually inspected, functionally tested, and confirmed operational? ® ❑ ❑ Does the flow of fuel stop at the dispenser if a leak is detected in the underAispenser 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? ® ❑ ❑ Which sensors initiate positive shut down? (Check all that apply.) ® Sump ® UnderAlspenser containment If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? ❑ ❑ Foran answer of "N" above describe In section W how and when these deficiencies were or will be corrected. IX. COMMENTS X. IN-TANK GAUGING TESTING to 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 monitodn . Has all input wiring been inspected for kinks and breaks in the cables and for proper entry and termination, including testing for ground ❑ ❑ ❑ 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? ❑ to Were ail probes reinstalled properly?Were all items on the equipment manufacturer's maintenance checklist completed? El ❑ Foran answer of "N" above describe in section X1 how and when these deficiencies were or will be corrected. XI. COMMENTS V = Vn¢ N a Nn NO = Nnt OnntlraNA