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Underground Storage Tank <br />Monitoring System Certification Form <br />8. IN -TANK GAUGING TESTING <br />® Check this box if tank gauging is used only for inventory control. <br />❑ Check this box if NO tank gauging equipment is installed. Yes No NA <br />(Do not complete this section if either box is checked.) <br />All wiring has been: 1) visually inspected for kinks, breaks and proper entry and ® ❑ ❑ <br />termination; and 2 tested for ground faults? <br />Were all in -tank gauging probes visually inspected for damage and residue buildup ® ❑ ❑ <br />to ensure that floats move freely, functionallv tested, and confirmed operational? <br />Was accuracy of system's product level readings tested? ® ❑ ❑ <br />Was accuracy of system's water level readings tested? ® ❑ ❑ <br />Were all probes reinstalled properly? ® ❑ ❑ <br />Were all items on the equipment manufacturer's maintenance checklist completed? I ® ❑ ❑ <br />Probe ID <br />Probe Model <br />Tanks Monitored <br />Pass <br />Fail <br />T-191 <br />VR -Mag -1 <br />T-191 <br />M <br />❑ <br />T-2 89 <br />VR -Mag -1 <br />T-2 89 <br />M <br />❑ <br />T-3 87 <br />VR -Mag -1 <br />T-3 87 <br />M <br />❑ <br />T-4 Diesel <br />VR -Mag -1 <br />T-4 Diesel <br />M <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />9. COMMENTS <br />Describe all answers marked "No" or "Fail" and proposed remedy. <br />List all monitoring equipment either replaced or repaired. <br />Notes: <br />1. UDC's are equipped with stand alone sensors for positive shutdown <br />only. <br />2. The 87 and 89 Leak detectors were adjusted 1 time then Passed. <br />Emergency Shut -Off "ESO" Testing Results & Checklist: <br />Site Data: <br />How many ESO switches are present onsite? _1 <br />Performance Test: <br />1. Does the ESO shutdown power to dispensers? Yes ® No ❑ <br />2. Does the ESO shutdown power to the STPs? Yes ® No ❑ <br />Post Test: <br />Is site's fueling equipment operational? Yes ® No ❑ <br />Page 5 of 6 <br />