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Underground Storage Tank <br /> Monitoring System Certification Form <br /> S. MONITORING SYSTEM AND PROGRAMMING <br /> A separate Monhoring System Certification Form must be prepared for each con"I panel. <br /> Make of Monitoring System Model cf Monitoring System Software Version Installed <br /> Control Panel Control Panel <br /> Reeder Foot TL - 50 123.02 <br /> Attach the post-certification reports if the monitoring system is capable ofgeneratrrrg Yes No N <br /> either, El Monitoring System Set-up 0 Alarm History Report <br /> All monitoring equipment is operational per manufacturers specifications" ® ❑ <br /> Secondary containment systems are free of damage, debris, or liquid? 9 ❑ <br /> Are the audible and visual alarms operational? 0 <br /> All sensors have been: 1) visually inspected for wiring kinks, breaks and residual 0 ❑ ❑ <br /> buildup on floats; and ) tested for functionality and confirmed operational? <br /> Are all sensors installed to detect a release at the earliest opportunity in the 9 ❑ ❑ <br /> secondary containment? <br /> The monitoring system set-up was reviewed, and proper settings ccnfirrned 0 D ❑ <br /> Was the ronitoring control panel's backup battery visually inspeOted, functicnaIly ER ❑ LJ <br /> tested, and confirmed operational? <br /> Does the flaw of fuel stop at the dispenser if a release is detected in the under- 0 0 <br /> dispenser containment? <br /> Does the turbine autornaticaily shut down if the piping secondary containment N D ❑ <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? ® ❑ El <br /> (Check all that apply) n Sump ® UDC <br /> It monitoring system alarms are relayed to a remote monitoring center, is all iR ❑ g <br /> 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 <br /> Page 2 of <br />