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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 <br />Model of Monitoring System <br />Software Version Installed <br />System Control Panel <br />Control Panel <br />333.05 <br />VEEDER ROOT <br />TLS 350 <br />Attach the post -testing reports if the monitoring system is capable of generating <br />Yes <br />No <br />NA <br />either: ❑ Monitoring System Set-up Report D Alarm History Report <br />Is all release detection equipment that was tested operational per manufacturer's <br />D <br />❑ <br />specifications? <br />Is the secondary containment free of damage, debris, or liquid? <br />D <br />❑ <br />I <br />Are the release detection audible and visual alarms operational? <br />D <br />❑ <br />Have all sensors been: 1) visually inspected for wiring kinks, breaks and residual <br />D <br />❑ <br />❑ <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? <br />D <br />❑ <br />❑ <br />Was the monitoring system set-up reviewed, and proper settings confirmed? <br />D <br />❑ <br />❑ <br />Was the monitoring system's backup battery visually inspected, functionally tested, <br />D <br />❑ <br />❑ <br />and confirmed operational? <br />Was it confirmed that the flow of hazardous substance stops at the dispenser if a <br />D <br />❑ <br />❑ <br />release is detected in the under -dispenser containment? <br />Does the pressure supply pump automatically shut down if the piping secondary <br />D <br />❑ <br />❑ <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 <br />D <br />❑ <br />❑ <br />shut down? (Check all that apply) ElContainment Sump ❑ UDC <br />If release detection alarms are relayed to a remote monitoring center, is all <br />D <br />❑ <br />❑ <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, <br />❑ <br />❑ <br />D <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 2 of 6 <br />