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Underground Storage Tank <br /> Monitoring System Cer ific <br /> 5• MONITO atton Form <br /> RING A Separa SYSTEM AND P <br /> te Monitorin ROGRgMMING <br /> Make 9 SYstem Certification Form must be prepared for each control panel. <br /> of Monitoring System <br /> Control Panel Model of Monitoring System Software Version Installed <br /> Control Panel <br /> v "c-Z �11N o0 <br /> Attach the post-certification reports if the monitoring�b <br /> either' system is capable of generating Yes No NA <br /> 0 Monitoring System Set-up © Alarm History Report <br /> All monitoring equipment is operational per manufacturer's specifications? <br /> Secondary containment systems are free of damage, debris, or liquid? <br /> Are the audible and visual alarms operational? <br /> All sensors have been: 1) visually inspected for wiring kinks, breaks and residual © 0 <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 <br /> secondary containment? <br /> The monitoring system set-up was reviewed, and proper settings confirmed? <br /> Was the monitoring control panel's backup battery visually inspected, functionally <br /> rl <br /> tested, and confirmed operational? <br /> —� Does the flow of fuel stop at the dispenser if a release is detected in the under- <br /> dispenser containment? <br /> Does the turbine automatically shut down if the piping secondary containment <br /> monitoring system fails to operatet�Qwelectrically <br /> if the piping secondary containment <br /> Does the turbine automatically shut <br /> 'n system detects a release? Which sensors initiate positive shut down? � <br /> monitoring Y Sum � UDC <br /> Check all that a I <br /> If monitoring system alarms are elay'd to a remote monitoring center, is all <br /> communication equipment opera <br /> Describe all answers marked uNo"or�Failn and proposed repaired in Section g <br /> List all monitoring eq Section 9. <br /> uipment either replaced o <br /> Page 2 0 <br />