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Underground Storage Tank Monitoring System Certification Form 5. MONITORING SYSTEM AND PROGRAMMING A separate Monitoring System Certification Form must be prepared for each control panel. Make of Monitoring System Model of Monitoring System Software Version Installed Control Panel Control Panel Veeder-Root TLS-350 133.06 Attach the post-certification reports if the monitoring system is capable of generating Yes No NA either, ❑✓ Monitoring System Set-up ✓❑ Alarm History Report All monitoring equipment is operational per manufacturer's specifications? ❑✓ ❑ Secondary containment systems are free of damage, debris, or liquid? E✓ r Are the audible and visual alarms operational? IT r All sensors have been: 1) visually inspected for wiring kinks, breaks and residual © ri F7 buildup on floats; and 2) tested for functionality and confirmed operational? Are all sensors installed to detect a release at the earliest opportunity in the secondary containment? The monitoring system set-up was reviewed, and proper settings confirmed? ❑✓ 0 Was the monitoring control panel's backup battery visually inspected, functionally ❑✓ ❑ ri tested, and confirmed operational? Does the flow of fuel stop at the dispenser if a release 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 release? Which sensors initiate positive shut down? ❑✓ ❑ ❑ Check all that apply) ✓❑ Sump ✓❑ UDC If monitoring system alarms are relayed to a remote monitoring center, is all ❑ ❑ communication equipment operational? Describe all answers marked "No"or "Fail"and proposed remedy in Section 9. List all monitoring equipment either replaced or repaired in Section 9 Page 2of6