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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 350 120 . 00 Attach the post- certification reports if the monitoring system is capable of generating Yes No NA either; Monitoring System Set- up E✓ Alarm History Report All monitoring equipment is operational per manufacturer' s specifications ? ❑✓ ❑ Secondary containment systems are free of damage , debris , or liquid ? 0 ❑ Are the audible and visual alarms operational ? EZI ❑ All sensors have been : 1 ) visually inspected for wiring kinks , breaks and residual 0 ❑ ❑ 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 El ❑ ❑ secondary containment? The monitoring system set- up was reviewed , and proper settings confirmed ? El ❑ ❑ Was the monitoring control panel ' s backup battery visually inspected , functionally 0 ❑ ❑ tested , and confirmed operational ? Does the flow of fuel stop at the dispenser if a release is detected in the under- ❑ ❑ 0 dispenser containment? Does the turbine automatically shut down if the piping secondary containment ❑ ❑ Fv] 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 ? ❑ ❑ 0 ( Check all that apply) ❑ Sump ❑ UDC If monitoring system alarms are relayed to a remote monitoring center , is all 0 ❑ ❑ 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 2 of 6