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