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Underground Storage Tank <br />Release Detection Equipment Testing Report Form <br />b. MONITORING SYSTEM AND PROGRAMMING <br />A separate Release Detection Equipment Testing Report Form mast be prepared for each <br />monitoring system. <br />Manufacturer of Monitoring Model of Monitoring System Software Version Installed <br />System Control Panel Control Parcel 336.02 <br />eeder Root TLS -350 <br />Attach the post -testing reports if the monitoring system is capable of generating <br />Yes <br />No <br />NA <br />either. a Monitoring System Set -yap Report N Alarm History Report <br />Is all release detection equipment that was tested operationai per manufacturer's <br />[d <br />❑ <br />specifications? <br />Is the secondary containment free of damage, debris, or liquid? <br />B <br />❑ <br />Are the release detection audible and visual alarms operational? <br />0 <br />❑ <br />Have ail sensors been: 9 ) visually inspected for wiring kinks, breaks and residual <br />© <br />0 <br />❑ <br />buildup on floats; and ) tested for functionality and confirmed operational? <br />Are all sensors installed to detect a release at the earliest opportunity"? <br />0 <br />0 <br />❑ <br />Was the monitofing system set-up reviewed, and proper settings confirmed"? <br />0 <br />E3 <br />❑ <br />Was the monitoring system's backup battery visually inspected, functionally tested, <br />� <br />0 <br />El <br />and confirmed operational"? <br />Was it confirmed that the flow of hazardous substance stops at the dispenser if a <br />fel <br />❑ <br />p <br />release is detected in the under -dispenser containment? <br />Does the pressure supply pump automatically shut down if the piping secondary <br />© <br />❑ <br />❑ <br />containment monitoring system fails to operate or is disconnected? <br />Does the pressure supply pump automatically shut doyen if the piping secondary <br />containment monitoring system detects a release? Which sensors initiate positive <br />❑ <br />0 <br />❑ <br />shut down"? (Check all that apply) IN Containment Sump 101 Uig <br />If release detection alarms are relayed to a remote monitoring center, is all <br />Q <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 />0 <br />0 <br />that the pipe contents drain back into the UST if the suction is released? <br />Describe afl answers marked "No" or "Fail" and the proposed remedy in Section B. <br />List ail equipment either replaced or repaired (including cleaning or adjustment) in Section 8. <br />Page 2 of 6 <br />