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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page 4 of ti <br /> VIII . MONITORING SYSTEM AND PROGRAMMING <br /> This section must be completed if a monitoring panel is used to perform leak detection monitorinp. Y N NA <br /> Are the visual and audible alarms operatlonal? Q ❑ ❑ <br /> Were all sensors visually inspected for kinks and breaks in the cables and for residual buildup to ensure that floats move freely. <br /> Q El 13 <br /> functionally 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 their Q ❑ Q <br /> pro er operation? <br /> Was monitoring system set-up reviewed to ensure proper settings? Q ❑ Q <br /> Was the monitoring panePs backup batteryvisually Inspected functionally tested and confirmed operatlonal? Q ❑ ❑ <br /> Does the flow of fuel stop at the dispenser if a leak is detected in the under-dispenser containment? J❑ ❑ [� <br /> Does the turbine automatically shut down if the piping secondary containment monitoring system falls to operate or is electrically ❑ ❑ Q <br /> disconnected? <br /> Does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak? ❑ ❑ Q <br /> Which sensors initiate positive shut down? 1Check all that app1V. 1 Sum r1 UnderAlspenser containment <br /> If alarms are relayed to a remote monitoring station is all communications equipment (e.g . modem ) operatlonal? ❑ ❑ <br /> For any answer of 'W" above describe in section 1X how and when these deficiencies were or will be corrected. <br /> IX, COMMENTS <br /> i <br /> i <br /> I <br /> i <br /> X. IN -TANK GAUGING TESTING <br /> lvl Check this box if tank gauging is used only for Inventory control. Do not complete this section. <br /> F] Check this box if NO tank gauging equipment is Installed (Do not complete this section. ) <br /> Y_ N NA <br /> This section must be completed if in- tank naugina 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 groundEl ❑ ❑ <br /> faults? <br /> Were all in tank gauping probes visually inspected for damage and residue buildup to ensure that floats move freely functionally tested. Q ❑ ❑ <br /> and confirmed operational? <br /> Was accuracy of system's product level readings tested? ❑ ❑ ❑ <br /> Was accuracy of system's water level readings tested? ❑ a <br /> .Were all probes reinstalled properly? ❑ El ❑ <br /> Were all Items on the equipment manufacturer's maintenance checklist completed? ❑ ❑ 1 ❑ <br /> For any answer of "M' above describe in section X1 how and when these deficiencies were or wUl be corrected. <br /> XI . COMMENTS <br /> l <br /> I <br />