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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page 4 of 6) <br /> Ulll. MONITORING SYSTEM AND PROGRAMMING <br /> This section must be completed if a monitoring panel is used to perform leak detection monitoring . Y N NA <br /> Are the visual and audible alarms operational? I✓ r <br /> F . <br /> Were all sensors visually inspected for kinks and breaks in the cables and for residual buildup to ensure that floats V r r <br /> move freely, functionally tested , and confirmed operational? <br /> Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not Iv r r <br /> interfere with their proper operation ? <br /> Was monitoring system set-up reviewed to ensure proper settings? Iv r r <br /> Was the monitoring panel's backup battery visually inspected , functionally tested , and confirmed operational? Iv r r <br /> Does the flow of fuel stop at the dispenser if a leak is detected in the under-dispenser containment? IV r r <br /> Does the turbine automatically shut down if the piping secondary containment monitoring system fails to operate or is I✓ r r <br /> electrically disconnected ? <br /> Does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak? Ie r r <br /> Which sensors initiate positive shut down? Check all that apply. ) r Sump W' Under-dispenser containment <br /> If alarms are relayed to a remote monitoring station , is all communications equipment (e . g . modem) operational ? r <br /> For any answer of "N " above, describe in section IX how and when these deficiencies were or will be corrected. <br /> IX. COMMENTS <br /> Use this section to provide any additional comments about the inventory of the equipment certified. <br /> X. IN TANK GAUGING TESTING <br /> Check this box if tank gauging is used only for inventory control . (Do not complete this section .) <br /> r Check this box if NO tank gauging equipment is installed . (Do not complete this section .) Y N NA <br /> This section must be completed if in-tank gauging 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 r r r <br /> testing for ground faults? <br /> E Were all in-tank gauging probes visually inspected for damage and residue buildup to ensure that floats move freely , r r r <br /> functionally tested , and confirmed operational? <br /> Was accuracy of system 's product level readings tested? r r r <br /> Was accuracy of system' s water level readings tested ? r r r <br /> Were all probes reinstalled properly? r r r <br /> I <br /> Were all items on the equipment manufacturer' s maintenance checklist completed ? r r r <br /> For any answer of W above, describe in section XI how and when these deficiencies were or will be corrected. <br /> Xl . COMMENTS <br /> Use this section to provide any additional comments about the inventory of the equipment certified. <br /> Y = Yes , N = No , NA = Not Applicable <br />