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Facie R.ygT/pN /nsfa//afio,� Y4gp en�p�a9e ,. `., <br /> cE�sio <br /> BRA„ hsioe d hk <br /> l <br /> Underground Storage Tank <br /> Monitoring System Certification Form <br /> MONITORING SYSTEM AND PROGRAMMING <br /> q separate Monitoring System Certification Form must be prepared for each control panel. <br /> vlake of Monitoring System Model of Monitoring System Software Version Installed <br /> control Panel Control Panel <br /> �(EEDER ROOT TLS-350 <br /> 334.01 <br /> Attach the post-certification reports if the monitoring system is capable of generating <br /> either; ®Monitoring System Set-up 0 Alarm History Report Yes No NA <br /> All monitoring equipment is operational per manufacturer's specifications? �� ❑ <br /> Secondary containment systems are free of damage, debris, or liquid? C� ❑ <br /> Are the audible and visual alarms operational? C� ❑ <br /> All sensors have been: 1) visually inspected for wiring kinks, breaks and residual <br /> buildup on floats; and 2)tested for functionality and confirmed operational? C� ❑ ❑ <br /> Are all sensors installed to detect a release at the earliest opportunity in the <br /> secondary containment'? ❑ <br /> The monitoring system set-up was reviewed, and proper settings confirmed? lK ❑ ❑ <br /> i <br /> Was the monitoring control panel's backup battery visually inspected, functionally I� ❑ ❑ <br /> tested, and confirmed operational? <br /> ��. Does the flow of fuel stop at the dispenser if a release is detected in the under- I� ❑ El <br /> containment?' <br /> a�9 Does the turbine automatically shut down if the piping secondary containment ❑ ❑ <br /> o N 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? iz ❑ ❑ <br /> (Check all that apply) ® Sump ® UDC <br /> If monitoring system alarms are relayed to a remote monitoring center, is all ❑ ❑ <br /> 9`S1% 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 /> " i <br /> Page 2 of 6 <br /> ,,2Pj <br />