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`£ S <br /> Underground Storage Tank <br /> Monitoring System Certification Form <br /> A ,separate Monitoring System Certification Form must be prepared for each control panel. <br /> Make of Monitgring 'S stern Model of Monitoring System Software Version Installed <br /> Z .Control Panel Control Panel <br /> 7Veeder-Root TLS 350 PLUS ! 336 . 00 <br /> Attach the post-certification reports if the monitoring system is capable of generating oIt <br /> either, <br /> xMonitoring System Set- up xAlarm History Report <br /> All monitoring equipment is operational per manufacturer' s specifications ? x <br /> Secondary containment systems arefree of damage , debris , or liquid ? x ❑ <br /> x <br /> Are the audible and visual alarms operational ? <br /> ❑ ' ' �x <br /> All sensors have been : 1 ) visually inspected for wiring kinks , breaks andresidual buildup on x ❑ ❑ <br /> floats ; and 2 ) tested for functionality and confirmed operational ? <br /> Are all sensors installed to detect a release at the earliest opportunity in the secondary x ❑ ❑ <br /> containment? <br /> The monitoring system set- up was reviewed , and proper settings confirmed ? x ❑ ❑ <br /> Was the monitoring control panel ' s backup battery visually inspected , functionally tested , x ❑ ❑ <br /> and confirmed operational ? <br /> Does the flow of fuel stop at the dispenser if a release is detected in the under-dispenser x ❑ <br /> containment? <br /> Does the turbine automatically shut down if the piping secondary containment monitoring x ❑ ❑ <br /> system fails to operate or is electrically disconnected ? <br /> Does the turbine automatically shut down if the piping secondary containment monitoring <br /> system detects a release ?Which sensors initiate positive shut down ? (Check all that X ❑ 171 <br /> apply ) xSump xUDC <br /> If monitoring system alarms are relayed to a remote monitoring center, is all communication ❑ ❑ x <br /> 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 /> RECEIVED <br /> OCT 18 2022 <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> Page 2 of 6 <br />