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Underground Storage Tank <br /> Monitoring System Certification Form <br /> [ -separaMONITO RING SYSTEM AND PROGRAMMING <br /> A separate_Monito_ring _.System Certification Form must be prepared for each control panel. <br /> ............... <br /> Make of Monitoring System Model of Monitoring System- Software Version Installed., ..., ,, . -- <br /> Control Panel Control Panel <br /> Veeder Root TLS-350 336.0 <br /> Attach the post-certification reports if the monitoring system is capable of generating <br /> z NA ,either; R7 Monitoring System Set-up r Alarm History Report Yes No <br /> All monitoring equipment is operational per manufacturer's specifications? <br /> ............ .............. ...............-.......... --------------- <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 <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? C 17 <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 /> tested, and confirmed operational? r Ll <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 M 17 r7 <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? E El r] <br /> ACheck all that apply) _C Su......p E UDC <br /> If monitoring system alarms are relayed to a remote monitoring center, is all <br /> communication equipment operational? E R7 <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 />