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Ih <br /> Underground Storage Tank <br /> Monitoring System Certification Form <br /> 5 M.OffrrO- RDIG 5YSTEM AND PROGRARUNI 3► <br /> A separate Montt ring System Certification Form must be prepared for each contra!panel. <br /> Make of Moniftorirl, System Model of Monitoring System Software Version Installed <br /> Control Panel Control Panel <br /> Attach the post cation reports if t monitoring system is capable of generating Yes No NA <br /> either, KMonito g System Set-up In Alarm History Report <br /> All monitoring equipment is operational per manufacturer's specifications? in ❑ <br /> Secondary contair ment systems are free of damage, debris, or liquid? ❑ <br /> Are the audible an I visual alarms operational? R ❑ <br /> All sensors have b Ben: 1) visually inspected for wiring kinks, breaks and residual <br /> buildup on floats; nd 2) tested for functionality and confirmed operational? <br /> Are all sensors ins ailed to detect a release at the earliest opportunity in the i� 8 ❑ <br /> secondary contain nt? <br /> The monitoring s tem set-up was reviewed, and proper settings confirmed? <br /> Was the monitorin 3 monitor' control panel's backup battery visually inspected, functionally in e <br /> tested, and confiff ied operational? q <br /> Does the flow of el stop at the dispenser if a release is detected in the under- �► 8 in <br /> dispenser contain ent? <br /> Does the turbine z utomatically shut down if the piping secondary containment <br /> monitoring systerr fails to operate or is electrically disconnected? <br /> Does the turbine E utomaticaNy shut down if the piping secondary containment <br /> monitoring systerr detects a release? Which sensors initiate positive shut down? ® ❑ <br /> Check all that a Sump Ff UDC <br /> If monitoring systE m alarms are relayed to a remote monitoring center, is all 8 ❑ <br /> communication ec uipment operational? <br /> Describe all answers marked `No'or`Fair and proposed remedy in Section 9. <br /> List all monitoring equipment either replaced or repaired in Section 9 <br /> Page 2 of 6 <br />