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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Pace a of s) <br /> --- . - _-- <br /> VHI . MONITORING SYSTEM AND PROGRAMMING <br /> This section must be completed if a monitoring panel is used to perform leak detection monitoring Y EEF NA <br /> Are the visual and audible alarms operational ? ® ❑ <br /> — � --- - - <br /> Were all sensors visually inspected for kinks and breaks in the cables and for residual buildup to ensure that floats move freely, ❑✓ ❑ ❑ <br /> functionaliv tested , and confirmed ocerational ? - <br /> j Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with ® ❑ ❑ <br /> their proper operation? — - — - -- - - ® El 11Was monitoring system set-up reviewed to ensure proper settings? <br /> Was the monitoring panel's backup battery visually inspected, functionally tested , and confirmed operational? ® El ❑ <br /> Does the flow of fuel stop at the dispenser if a leak is detected in the under-dispenser containment? ® ❑ ❑ <br /> Does the turbine automatically shut down if the piping secondary containment monitoring system fails to operate or is electrically i El ❑ <br /> disconnected? - <br /> Does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak? ® i ❑ ❑ <br /> Which sensors initiate positive shut down? (Check all that apply.) ® Sump ❑ underrDispenser Containment <br /> station, is <br /> ons equipment <br /> , , modem) operational? <br /> 1 IFor any answer of `W' above, describein Sectiloo IX how and when these gdeficiencies were or will be corrected. <br /> ( ❑ ❑ <br /> �— y ed. — <br /> i 1X9 COMMENTS <br /> Replaced TLS battery for I Purpose . <br /> i <br /> I <br /> 1 <br /> f � <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-fank augin� is used to perform leak detection monitories — - <br /> Has all input wiring been inspected for kinks and breaks in the cables and for proper entry and termination , including testing for ❑ ❑ ( ❑ <br /> round faults? - ----- - <br /> Were all in-tank gauging probes visually inspected for damage and residue buildup to ensure that floats move freely, functionally ❑ ❑ ❑ <br /> tested , and confirmed o )erational . - ___ I <br /> 0 <br /> _I - _- _ _ -- - -- - r <br /> Was accuracy of system's product level readings tested ? _ _____ ❑ i ❑ i ❑ <br /> Was accuracy of system's water level readings tested ? _;_�E ❑ ❑ <br /> Were all probes reinstalled properly? ❑ ❑ ❑ <br /> Were all items on the equipment manufacturer`s maintenance checklist completed? <br /> For any answer of "tN " above, describe in Section Xl how and when these deficiencies were or will be corrected. <br /> XI , COMMENTS <br /> i <br /> I <br /> Y = Yes, N = No, NA = Not Applicable <br /> i <br />