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Underground Storage Tank <br /> Monitoring System Certification Form <br /> 5. MONITORING SYSTEM AND PROGRAMMING <br /> A separate Monitoring System Certificaffon Form mast be prepared for each con r'ol panel <br /> Make of Monitodng System Model of Monitodng System� Software Version Installed <br /> Control Panel Control Panel <br /> Veeder Root TLS 350 336.02 <br /> Attach the post-certification reports if the moniforing system is capable of generating Yes X10 SIA <br /> either; on Monitoring System Set-up Ej Alarm History Report <br /> All monitoring equipment is operational per manufacturer's specifications? ® C <br /> Secondary containment systems are free of damage, debris, or liquid? E 0 <br /> Are the audible and visual alarms operational' <br /> Alf sensors have been: 4) visually inspected for wiring kinks, breaks and residual 0 <br /> buildup on floats; and ) tested for functionality and confirmed aperationai? <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? r] Ell <br /> Was the monitoring control panel's backup battery visually inspected, functionally <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 /> Dees the to rbine automatically shut down if the piping secondo ry containment <br /> monitoring system fails to operate or is electrically disconnected? <br /> Does the turbine automatically shut doom if the piping secondary containment <br /> monitoring system detects a release? Which sensors initiate positive shut down'? � <br /> _( lheck all that�a pI M Sum F] UDC <br /> If monitoring system alarms are relayed to a remote monitoring center. is all <br /> communication equipment operational? <br /> Describe aif answers marked °No"or r ail"arra proposed remedy if? Section 9. <br /> List ail monitoring equipment either replaced or repaired in Seclion 9 <br /> Page 2 of 6 <br />