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Underground Storage Tank <br /> Monitoring System Certification Form <br /> S. MONITORING SYSTEM[ AND PROGRAMMING <br /> A separate Monitoring System Cerfification Farm must be prepared for each control panel. <br /> Make of Monitoring System Model of Monitoring System Software Version Installed <br /> Control Panel Control Panel <br /> VR TLS-350 336.02 <br /> Attach the post-certification reports if the monitoring system is capable of generating Yes No NA <br /> either: © Monitoring System Set-up F Alarm History Deport <br /> All monitoring equipment is operational per manufacturer's specifications? a <br /> Secondary containment systems are free of damage, debris, or liquid? <br /> Are the audible and visual alarms operational? fM rl <br /> All sensors have been: 'i) visually inspected for wiring kinks, breaks and residual <br /> bulid up 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 /> tested, and confirmed operational? <br /> Does the flaw of fuel stop at the dispenser if a release is detected in the under- <br /> dispenser containment? <br /> Does the to{bine 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? Which sensors initiate positive shut dawn? E El M <br /> Check all that apply) Sump F3 UD <br /> If monitoring system alarms are relayed to a remote monitoring center, is all ® � <br /> communication equipment operational? <br /> Desc6be all answers marked "Ne" or "Fail" and proposed rerrmedy rn Section 9. <br /> List all men itoring equ foment either replaced or repaired in Section 9 <br /> Page 2 of 6 <br />