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UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page a of s) VilL MONITORING SYSTEM AND PROGRAMMING This section must be completed If a monitoring panel is used to perform leak detection monitoring. Y III,IIIN NA Are the visual and audible alarms operational? ❑ El Were all sensors visually inspected for kinks and breaks In the cables and for residual buildup to ensure that floats move freely, © ❑ ❑ functionally tested , and confirmed operational? ' Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their ❑ ❑ proper operation? I ElWas monitoring system set-up reviewed to ensure proper settings? Was (he monitoring panel's backup battery visually inspected , functionally tested, and confirmed operational? ® El Does the flow of fuel stop at the dispenser If a leak Is detected in the underpolspenser containment? El El Does the turbine automatically shut down if the piping secondary containment monitoring system falls to operate or is electrically ,d ❑ ❑ disconnected? Does the turbine automatically shut down if the piping secondary contalnme t�monitoring ystem detects a leak? ®� ❑ El Which sensors initiate positive shut down? (Check all Ilia ( apply.) Sump Under4spgnser containment If alarms are relayed to a remote monitoring station , is all communications equipment (e . g . modem) operational? ❑ ❑ 1 ❑ ror finZ answer of "N" above, describe In section IX how and when these deffclencles were or will he corrected. IX . COMMENTS X . IN-TANK GAUGING. TESTING Cyt Check this box if tank gauging is used only for Inventory control. (Do not complete this section.) Y N NA (l Check this box if NO tank gauging equipment is Installed. (Do not complete this section.) 'rills section must be completed if inmitankgauging is used to perforra leak detection monitorin . I-las all Input wiring been inspected for kinks and breaks In the cables and for proper entry and termination , including testing for ground ❑ ❑ ❑ faults ? _ Were all ItHank gauging probes visually Inspected for damage and reDidue buildup to ensure that floats move freely, functionally tested , ❑ ❑ ❑ and confirmed operational? El Was accuracy of system's product level readings tested? ❑ El Was accuracy of system's water level readings tested? EI El El Were all probes reinstalled properly? ❑ Were all items on the equipment manufacturer`s maintenance checklist completed? Ell ❑ ❑ For any answer of "N " above describe in section XI now and when these deffclencies were or will be corrected. XI . COMMENTS i Y Yes. N = No, NA Not Applicable