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Underground Storage Tank <br />Monitoring System Certification Form <br />5. MONITORING SYSTEM AND PROGRAMMING <br />IN <br />A separate Monitoring System Certificatiorr Form must be prepared for each control panel. <br />Make of Monitoring System <br />Model of Monitoring System <br />Software Version Installed <br />Control Panel <br />Control Panel <br />Veeder 'toot <br />TLS -350 <br />333.08 <br />Attach the post -certification reports if the monitoring system is capable of generating Yes <br />No <br />NAeither, <br />0Monitoring System Set-up ® Alarm History Report <br />All monitoring equipment is operational per manufacturer's specifications? <br />9 <br />❑ <br />Secondary containment systems are free of damage, debris, or liquid"? <br />® <br />❑ <br />Are the audible and visual alarms operational? <br />M <br />D <br />All sensors have been: 1) visually inspected for icing kinks, breaks and residual <br />® <br />❑ <br />❑ <br />buildup on floats; and ) tested for functionality and confirmed operational ? <br />Are a I I sefnsors installed to detect a release at the earliest opportunity in the <br />® <br />❑ <br />❑ <br />eoondary containment? <br />0 <br />El <br />❑ <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 />® <br />❑ <br />❑ <br />tested, and confirmed operational? <br />® <br />❑ <br />❑ <br />Does the flow of fuel stop at the dispenser if a release is detected in the under- <br />dispenser containment? <br />0 <br />❑ <br />0 <br />Does the turbine automatically shut down if the piping secondary containment <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"? VVhich sensors initiate positive shut dowry? <br />0 <br />0 <br />❑ <br />(Check all that apply) m S ump 0 tlD <br />If monitoring system alarms are relayed to a remote monitoring center, is all <br />® <br />❑ <br />❑ <br />communication equipment operational? <br />Descfibe al/ answers marked "No" or uFair and proposed remedy in Section 9. <br />List all monitoring equipment either replaced or repaired in Section 9 <br />Page 2 of <br />