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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page 4 of 6) <br /> Vlll . 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? R ❑ ❑ <br /> Were all sensors visually inspected for kinks and breaks in the cables and for residual buildup to ensure that floats move freely, ❑ F]functional) tested , and confirmed operational? <br /> IX Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with 0 FJ El <br /> proper operation? <br /> Was monitoring system set-up reviewed to ensure proper settings? Q ❑ ❑ <br /> Was the monitoring panel's backup battery visually inspected , functionally tested , and confirmed operational? o ❑ ❑ <br /> Does the flow of fuel stop at the dispenser if a leak is detected in the under-dispenser containment? Q ❑ ❑ <br /> Does the turbine automatically shut down if the piping secondary containment monitoring system fails to operate or is electrically El ❑ a <br /> disconnected ? <br /> Does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak? <br /> Which sensors initiate positive shut down? (Check all that apply.) Sump Q Under-Dispenser Containment M ❑ ❑ <br /> If alarms are relayed to a remote monitoring station , is all communications equipment (e.g . , modem) operational ? ❑ ❑ 0 <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 /> Rrk <br /> t P <br /> Fp s2 ? 0 ?0 <br /> ENV € RONIV _ @ TA 1111EALT <br /> 0 E PA Re{ <br /> X. IN -TANK GAUGING TESTING <br /> ❑X Check this box if tank gauging is used only for inventory control. (Do not complete this section.) <br /> ❑ 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 testing for 11 Elround faults? <br /> El <br /> Were all in-tank gauging probes visually inspected for damage and residue buildup to ensure that floats move freely, functionally F1 El Eltested , and confirmed operational? <br /> Was accuracy of system's product level readings tested? ❑ ❑ <br /> Was accuracy of system's water level readings tested? ❑ ❑ ❑ <br /> Were all probes reinstalled properly? ❑ R <br /> Were all items on the equipment manufacturer's maintenance checklist completed ? ❑ El I E <br /> For any answer of "N" above, describe in Section X/ how and when these deficiencies were or will be corrected. <br /> Xl . COMMENTS <br /> Y = Yes, N = No, NA = Not Applicable <br />