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Underground Storage Tank <br /> Release Detection Equipment Testing Report Form <br /> 5. MONITORING SYSTEM AND PROGRAMMING <br /> A separate Release Detection Equipment Testing Report Form must be prepared for each <br /> monitoring system. <br /> Manufacturer of Monitoring Model of Monitoring System Software Version Installed <br /> System Control Panel Control Panel 333.06 <br /> VEEDER ROOT TLS 350 <br /> Attach the post-testing reports if the monitoring system is capable of generating Yes No NA <br /> either. ❑ Monitoring System Set-up Report 0 Alarm History Report <br /> Is all release detection equipment that was tested operational per manufacturer's 0 ❑ <br /> specifications? <br /> Is the secondary containment free of damage, debris, or liquid? 0 ❑ <br /> Are the release detection audible and visual alarms operational? 0 ❑ <br /> Have all sensors been: 1) visually inspected for wiring kinks, breaks and residual 0 ❑ ❑ <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? 0 ❑ ❑ <br /> Was the monitoring system set-up reviewed, and proper settings confirmed? 0 ❑ ❑ <br /> Was the monitoring system's backup battery visually inspected, functionally tested, 0 ❑ ❑ <br /> and confirmed operational? <br /> Was it confirmed that the flow of hazardous substance stops at the dispenser if a 0 ❑ ❑ <br /> release is detected in the under-dispenser containment? <br /> Does the pressure supply pump automatically shut down if the piping secondary 0 ❑ ❑ <br /> containment monitoring system fails to operate or is disconnected? <br /> Does the pressure supply pump automatically shut down if the piping secondary <br /> containment monitoring system detects a release? Which sensors initiate positive 0 ❑ ❑ <br /> shut down? (Check all that apply) ElContainment Sump 0 UDC <br /> If release detection alarms are relayed to a remote monitoring center, is all 0 ❑ ❑ <br /> communication equipment operational? <br /> If there is any buried single-wall suction hazardous substance piping, was it <br /> confirmed using the inspection method approved by the Unified Program Agency, ❑ ❑ 0 <br /> that the pipe contents drain back into the UST if the suction is released? <br /> Describe all answers marked "No"or "Fail'and the proposed remedy in Section 8. <br /> List all equipment either replaced or repaired (including cleaning or adjustment) in Section 8. <br /> Page 2of6 <br />