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UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page 4 of 6) Ville 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 ? QrEl El Were all sensors visually inspected for kinks and breaks in the cables and for residual buildup to ensure that floats move freely, Elfunctional) tested , and confirmed o erational? Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with F]their ro er o eration? Was monitoring system set-up reviewed to ensure proper settings? 0 ❑ Was the monitoring panel's backup battery visually inspected , functionally tested , and confirmed operational? Q 0 ❑ Does the flow of fuel stop at the dispenser if a leak is detected in the under-dispenser containment? ❑X ❑ ❑ 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? FX1 ❑ ❑ Which sensors initiate positive shut down? (Check all that apply.) ❑X Sump Q Under-Dispenser Containment If alarms are relayed to a remote monitoring station, is all communications equipment (e.g . , modem) operational? Q ❑ ❑ For any answer of "M' above, describe in Section IX how and when these deficiencies were or will be corrected. IX. COMMENTS i i X. IN -TANK GAUGING TESTING FXCheck 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 ❑ ❑ ❑ round faults? Were all in-tank gauging probes visually inspected for damage and residue buildup to ensure that floats move freely, functionally0 El ❑ tested , and confirmed operational? Was accuracy of system's product level readings tested ? ❑ ❑ ❑ Was accuracy of system's water level readings tested? ❑ I ❑ I ❑ !' Were all probes reinstalled properly? El ❑ 1:1 Were all items on the equipment manufacturer's maintenance checklist completed? ❑ 1 ❑ 1 ❑ For any answer of "M' above, describe in Section XI how and when these deficiencies were or will be corrected. XI . COMMENTS Y = Yes, N = No, NA = Not Applicable