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Underground Storage Tank <br /> Monitoring System Certification Form <br /> 5. MONITORING SYSTEM AND PROGRAMMING <br /> A separate Monitoring System Certification Form must be prepared for each control panel. <br /> Make of Monitoring System Model of Monitoring System Software Version Installed <br /> Control Panel Control Panel <br /> Veeder Root TLS-350R 333.03 <br /> Attach the post-certification reports if the monitoring system is capable of generating Yes No NA <br /> either, 6IMonitoring System Set-up 0 Alarm History Report <br /> All monitoring equipment is operational per manufacturer's specifications? 0 Ll <br /> Secondary containment systems are free of damage, debris, or liquid? R) Ll <br /> Are the audible and visual alarms operational? 21 E) <br /> All sensors have been: 1) visually inspected for wiring kinks, breaks and residual 0 L1 D <br /> buildup on floats; and 2) tested for functionality and confirmed operational? <br /> Are all sensors installed to detect a release at the earliest opportunity in the 0 Lj Lj <br /> secondary containment? <br /> The monitoring system set-up was reviewed, and proper settings confirmed? 0 El 11 <br /> Was the monitoring control panel's backup battery visually inspected; functionally 0 Lj Ljtested; and confirmed operational? <br /> Does the flow of fuel stop at the dispenser if a release is detected in the under- 0 Lj Lj <br /> dispenser containment? <br /> Does the turbine automatically shut down if the piping secondary containment <br /> monitoring system fails to operate or is electrically disconnected? <br /> Does the turbine automatically shut down if the piping secondary containment <br /> monitoring system detects a release? Which sensors initiate positive shut down? 21 Ll L] <br /> (Check all that apply) ® Sump Z UDC <br /> If monitoring system alarms are relayed to a remote monitoring center, is all 21 Ll Lj <br /> communication equipment operational? <br /> Describe all answers marked "No"or"Fail"and proposed remedy in Section 9. <br /> List all monitoring equipment either replaced or repaired in Section 9 <br /> Page 2 of 6 <br />