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UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page a of s) Vlll , 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? O ❑ ❑ Were all sensors visually inspected for kinks and breaks in the cables and for residual buildup to ensure that floats move freely, Q El tested , and confirmed operational? Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with o ❑ ❑ their proper operation? Was monitoring system set-up reviewed to ensure proper settings? Q Q ❑ Was the monitoring panel's backup battery visually inspected , functionally tested , and confirmed operational? Q ❑ ❑ Does the flow of fuel stop at the dispenser if a leak is detected in the under4spenser containment? z ❑ Does the turbine automatically shut down if the piping secondary containment monitoring system falls 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.) ❑X Sump Q Under-Dispenser Containment ❑ If alarms are relayed to a remote monitoring station, is all communications equipment (e,g „ modem) operational? ❑X ❑ ❑ For any answer of "N " above, describe in Section IX how and when these defrciencles 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 inwtank gauging is used to perform leak detection monitoring. j Has all input wiring been inspected for kinks and breaks in the cables and for proper entry and termination , including testing for n ❑ ❑ round faults? tom! Were all in-tank gauging probes visually inspected for damage and residue buildup to ensure that floats move freely , functionally X ❑ ❑ tested, and confirmed operational? Was accuracy of system's product level readings tested? ❑X ❑ 1 ❑ Was accuracy of system's water level readings tested? X❑ ❑ ❑ Were all probes reinstalled property? ❑X 1 ❑ ❑ d Were all items on the equipment manufacturers maintenance checklist completed? FIE 1 ❑ 1 ❑ For any answer of "N" above, describe In Section XI how and when these deficiencies were or will be corrected. XI . COMMENTS Y = Yes, N = No. NA = Not Applicable r i'