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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM(Page 4 of 6) <br /> VIII. MONITORING SYSTEM AND PROGRAMMING <br /> This section must be completed if a monitoring panel is used to perform leak detection monitoring. Y N NA <br /> Are the visual and audible alarms operational? © ❑ ❑ <br /> Were all sensors visually inspected for kinks and breaks in the cables and for residual buildup to ensure that floats move freely, ❑ 1:1functionally tested,and confirmed operational? <br /> Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with ® L] El <br /> proper operation? <br /> Was monitoring system set-up reviewed to ensure proper settings? 10 ❑ ❑ <br /> Was the monitoring panel's backup battery visually inspected,functionally tested,and confirmed operational? W1 ❑ ❑ <br /> Does the flow of fuel stop at the dispenser if a leak is detected in the under-dispenser containment? V1 ❑ ❑ <br /> Does the turbine automatically shut down if the piping secondary containment monitoring system fails to operate or is electrically El Eldisconnected? <br /> Does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak? E] E]Which sensors initiate positive shut down? (Check all that apply) ®Sump Elunder-DispenserContainment <br /> If alarms are relayed to a remote monitoring station,is all communications equipment(e.g.,modem)operational? I W1 I ❑ ❑ <br /> For any answer of"N"above,describe in Section IX how and when these deficiencies were or will be corrected. <br /> IX. COMMENTS <br /> Replaced TLS Battery for PM Purpose. <br /> 1 'A, ... <br /> 4 ZOZJ <br /> X. IN-TANK GAUGING TESTING <br /> Check this box if tank gauging is used only for inventory control.(Do not complete this section.) <br /> ❑Check this box if NO tank gauging equipment is installed.(Do not complete this section.) Y N NA <br /> This section must be completed If In-tank gauging is used to perform leak detection monitoring. <br /> Has all input wiring been inspected for kinks and breaks in the cables and for proper entry and termination,including testing for ® 1:1 1:1round faults? <br /> Were all in-tank gauging probes visually inspected for damage and residue buildup to ensure that floats move freely,functionally El ❑ <br /> tested,and confirmed operational? <br /> Was accuracy of system's product level readings tested? ❑ ❑ Q <br /> Was accuracy of system's water level readings tested? ❑ <br /> Were all probes reinstalled properly? ❑ <br /> Were all items on the equipment manufacturer's maintenance checklist completed? © ❑ ❑ <br /> For any answer of"N"above,describe In Section X1 how and when these deficiencies were or will be corrected. <br /> XI. COMMENTS <br /> Y=Yes,N=No,NA=Not Applicable <br />