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Underground Storage Tank Monitoring System Certification Form Page 2 of 6 5. MONITORING SYSTEM AND PROGRAMMING A separate Monitoring System Certification Form must be prepared for each control panel. Make of Monitoring System Control Panel Veeder-Root Model of Monitoring System Control Panel TLS-300C Software Version Installed 424.01 Attach the post-certification reports if the monitoring system is capable of generating either; ☒Monitoring System Set-up ☒ Alarm History Report Yes No NA All monitoring equipment is operational per manufacturer’s specifications? ☒ ☐ Secondary containment systems are free of damage, debris, or liquid? ☒ ☐ Are the audible and visual alarms operational? ☒ ☐ All sensors have been: 1) visually inspected for wiring kinks, breaks and residual 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? ☒ ☐ ☐ Was the monitoring control panel’s backup battery visually inspected, functionally 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